Hybrid Manager I – Medical Management

Posted 1 hour ago

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About the role

  • Manager I overseeing a team of clinicians to promote quality member outcomes for Elevance Health. Managing clinical resources and ensuring adherence to medical policies in a hybrid work environment.

Responsibilities

  • manage a team of clinicians charged with promoting quality member outcomes
  • optimize member benefits
  • promote effective use of resources
  • ensures adherence to medical policy and member benefits in providing medically appropriate service
  • authorizing inpatient admissions, outpatient services, focused surgical and diagnostic procedures, out of network services
  • appropriateness of treatment setting by utilizing applicable medical policy and industry standards
  • steering members to appropriate providers, programs or community resources
  • applies clinical knowledge to work with facilities and providers for care-coordination
  • managing appeals for services denied
  • hiring, training, coaching, counseling, and evaluating performance of direct reports

Requirements

  • Requires a HS diploma or equivalent
  • minimum of 5 years acute care clinical experience
  • current, active, valid unrestricted RN license to practice as a health professional within the scope of practice in applicable state(s) or territory of the United States

Benefits

  • merit increases
  • paid holidays
  • Paid Time Off
  • incentive bonus programs
  • medical
  • dental
  • vision
  • short and long term disability benefits
  • 401(k) +match
  • stock purchase plan
  • life insurance
  • wellness programs
  • financial education resources

Job title

Manager I – Medical Management

Job type

Experience level

Mid levelSenior

Salary

Not specified

Degree requirement

High School Diploma

Location requirements

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