Senior Medical Management Clinician

Elevance Health

Medical Management Clinician Senior handling complex clinical cases and process improvement initiatives in a healthcare company. Position allows for virtual work with in-person training sessions, preferred residency in Virginia.

Posted 7/8/2026full-timeRichmond • Virginia • 🇺🇸 United StatesSenior💰 $31 - $57 per hourWebsite

Core Competencies

Role fit

Core Competencies

Use this summary to align your resume positioning with the role.

Demonstrates extensive clinical experience and utilization review expertise, with a strong focus on applying medical policies and clinical guidelines. Collaborates effectively with leadership to enhance training materials and improve processes within the healthcare setting.

Highest-signal resume keywords

Clinical ExperienceUtilization Review ExperienceLPN/LVN or RN LicenseProcess Improvement InitiativesLTSS Experience

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Medical Policy ApplicationClinical Guideline AssessmentPre-Certification ReviewConcurrent ReviewRetrospective ReviewOut of Network ReviewTreatment Setting Review

Soft Skills

CollaborationResourcefulnessTraining Development

Certifications & Qualifications

LPN LicenseRN License

Industry Keywords

HealthcareClinical GuidelinesProcess ImprovementVirginia ResidencyLTSS

About the role

Key responsibilities & impact

Responsible for complex cases that may require evaluation of multiple variables against guidelines when procedures are not clear
Serves as a resource to lower-level clinicians and staff
May collaborate with leadership to assist in process improvement initiatives
Assesses and applies medical policies and clinical guidelines within scope of licensure
Conducts and may approve pre-certification, concurrent, retrospective, out of network and/or appropriateness of treatment setting reviews
Refers complex or unclear reviews to higher level nurses and/or Medical Directors
Collaborates with leadership in enhancing training and orientation materials

Requirements

What you’ll need

Requires H.S. diploma or equivalent
Requires a minimum of 6 years of clinical experience and/or utilization review experience
Current active, valid and unrestricted LPN/LVN or RN license and/or certification to practice as a health professional within the scope of licensure in applicable state(s)
Virginia residency preferred
RN license in the state applicant resides in is highly preferred
Prior LTSS experience highly preferred

Benefits

Comp & perks

Comprehensive benefits package
Incentive and recognition programs
Equity stock purchase
401k contribution
Paid holidays
Paid Time Off
Medical, dental, and vision benefits
Short and long term disability benefits
Wellness programs
Financial education resources