Medical Management Clinician

Elevance Health

Medical Management Clinician ensuring appropriate and consistent administration of plan benefits. Work virtually with clinical information and medical necessity assessment with Florida-based locations.

Posted 7/9/2026full-timeTampa • Florida • 🇺🇸 United StatesMid-LevelSeniorWebsite

About the role

Key responsibilities & impact

Responsible for moderately complex cases that may require evaluation of multiple variables against guidelines when procedures are not clear
Work may be facilitated, in part, by algorithmic or automated processes
Handles moderately complex benefit plans and/or contracts
Works on reviews that may require guidance by more senior colleagues and/or management
May serve as a resource to less experienced staff
Conducts and may approve precertification, concurrent, retrospective, out-of-network, and/or appropriateness of treatment setting reviews by assessing clinical information against appropriate medical policies, clinical guidelines, and the relevant benefit plan/contract
May process a medical necessity denial determination made by a Medical Director
May work directly with healthcare providers to obtain and understand clinical information
Refers complex or unclear reviews to higher level nurses and/or Medical Directors
May educate members about plan benefits and physicians
Does not issue medical necessity non-certifications

Requirements

What you’ll need

Requires H.S. diploma or equivalent
Requires a minimum of 4 years of clinical experience and/or utilization review experience
Current active, valid and unrestricted LPN/LVN license or RN license and/or certification to practice as a health professional within the scope of licensure in applicable state(s) or territory of the United States required
Multi-state licensure is required if this individual is providing services in multiple states
Bachelor's degree is strongly preferred
Current active RN License is strongly preferred

Benefits

Comp & perks

Merit increases
Paid holidays
Paid Time Off
Incentive bonus programs
Medical benefits
Dental benefits
Vision benefits
Short and long term disability benefits
401(k) + match
Stock purchase plan
Life insurance
Wellness programs
Financial education resources

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills & Tools

Clinical EvaluationUtilization ReviewPrecertification ReviewConcurrent ReviewRetrospective ReviewOut-Of-Network ReviewTreatment Setting ReviewMedical Necessity DeterminationBenefit Plan AnalysisClinical Guideline Assessment

Soft Skills

CommunicationCollaborationMentoring