Medical Management Clinician Associate

Elevance Health

Medical Management Clinician Associate responsible for benefit plans administration and medical necessity assessments. Requires clinical experience and appropriate licensure for virtual healthcare role.

Posted 7/14/2026full-timeLatham • California, Nevada, New York, Washington • 🇺🇸 United StatesJuniorMid-Level💰 $28 - $43 per hourWebsite

Core Competencies

Role fit

Core Competencies

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Demonstrates expertise in clinical assessment and utilization review, ensuring compliance with medical policies and benefit plans. Proficient in conducting precertification and treatment setting reviews while maintaining multi-state licensure as a health professional.

Highest-signal resume keywords

Clinical ExperienceUtilization Review ExperienceLPN/LVN or RN LicenseMedical Policy AssessmentBenefit Plan Administration

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Clinical AssessmentUtilization ReviewPrecertification ReviewConcurrent ReviewRetrospective ReviewTreatment Setting ReviewMedical Necessity AssessmentPlan Benefits AdministrationScripted Algorithms ApplicationContract Handling

Certifications & Qualifications

LPN LicenseLVN LicenseRN License

Industry Keywords

Medical PoliciesClinical GuidelinesBenefit PlansMulti-State LicensureHealth Professional Certification

About the role

Key responsibilities & impact

Ensuring appropriate, consistent administration of plan benefits by reviewing clinical information and assessing medical necessity under relevant guidelines and/or medical policies
Confirming medical services are appropriate based on assigned benefit plan, medical policies, clinical guidelines, plan benefits, and/or scripted algorithms
Handling less complex benefit plans and/or contracts
Conducting 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
Referring complex or non-routine reviews to more senior nurses and/or Medical Directors

Requirements

What you’ll need

Requires H.S. diploma or equivalent
Requires a minimum of 2 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) or territory of the United States required
Multi-state licensure is required if providing services in multiple states

Benefits

Comp & perks

Comprehensive benefits package
Incentive and recognition programs
Equity stock purchase
401k contribution
Paid Time Off