Manager of Medical Management team at Elevance Health optimizing member benefits and promoting quality outcomes. Requires RN license, management experience, and clinical expertise.
Responsibilities
Manage a team of clinicians charged with promoting quality member outcomes
Optimize member benefits
Promote effective use of resources
Ensure adherence to medical policy and member benefits
Authorize inpatient admissions, outpatient services, focused surgical and diagnostic procedures, and appropriateness of treatment setting
Apply clinical knowledge to work with facilities and providers for care-coordination
Manage appeals for services denied
Serve as mentor to lower leveled managers
Develop and manage annual operating budget
Hire, train, coach, counsel, and evaluate performance of direct reports
Requirements
Requires a HS diploma or equivalent
Minimum of 5 years acute care clinical experience
Minimum of 2 years prior management experience
Current, active, valid unrestricted RN license to practice as a health professional within the scope of licensure in applicable state(s) or territory of the United States required
BS preferred
Demonstrated clinical expertise and leadership experience
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