Healthcare Benefits Coordinator

2 days ago


Norfolk, Virginia, United States Elevance Health Full time

About Us

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Elevance Health is a health company dedicated to improving lives and communities - and making healthcare simpler. With a longstanding history in the healthcare industry, we are looking for leaders at all levels of the organization who are passionate about making an impact on our members and the communities we serve.

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Job Description

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The Clinical Utilization Review Specialist is responsible for working primarily with healthcare providers to help ensure appropriate and consistent administration of plan benefits through collecting clinical information required to preauthorize services, assess medical necessity, out-of-network services, and appropriateness of treatment setting and applying appropriate medical policies, clinical guidelines, plan benefits, and/or scripted algorithms within scope of licensure.

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Key Duties

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  • Conducts pre-certification, inpatient, retrospective, out-of-network, and appropriateness of treatment setting reviews within scope of licensure by utilizing appropriate medical policies and clinical guidelines.">
  • Develops relationships with physicians, healthcare service providers, and internal and external customers to help improve health outcomes for members.">
  • Applies clinical knowledge to work with facilities and providers for care coordination.">
  • May access and consult with peer clinical reviewers, Medical Directors, and/or delegated clinical reviewers to help ensure medically appropriate, quality, cost-effective care throughout the medical management process.">
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Required Skills and Qualifications

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The ideal candidate will possess a high school diploma or equivalent, and a minimum of 2 years of clinical or utilization review experience, as well as a current active unrestricted license or certification as a LPN, LVN, or RN 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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Preferred Experience

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Prior experience in a similar role or in the healthcare industry is highly desirable.

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Work Environment

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This role can be performed remotely, but candidates must reside within 50 miles or 1-hour commute each way of a relevant Elevance Health location.

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Salary Information

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The estimated annual salary for this position is $64,000 - $80,000, based on location and experience.

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Benefits

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We offer a comprehensive benefits package, including competitive salary, 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, and financial education resources.

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