Medical Review Specialist

3 weeks ago


Norfolk, Virginia, United States Elevance Health Full time
Job Description

In this role, you will work as a Medical Review Specialist with Elevance Health. This is a remote position, but candidates must reside within 50 miles of one of our locations.

Your primary duties may include:

  • Conducting pre-certification, inpatient, retrospective, out-of-network and appropriateness of treatment setting reviews by utilizing medical policies and clinical guidelines in compliance with department guidelines and consistent with members' eligibility, benefits, and contract.
  • Developing relationships with physicians, healthcare service providers, and internal and external customers to improve health outcomes for members.
  • Applying clinical knowledge to work with facilities and providers for care coordination.
  • Maintaining up-to-date knowledge of medical policies, clinical guidelines, and regulatory requirements.

The estimated salary for this position is $65,000-$80,000 per year, depending on experience.



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