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
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