Clinical Healthcare Professional

3 days ago


Tampa, Florida, United States Elevance Health Full time

Are you passionate about delivering high-quality, patient-centered care? Do you want to make a real impact on the lives of our members? We are seeking a skilled Medical Management Nurse to join our team at Elevance Health.

As a Clinical Healthcare Professional, you will have the opportunity to work closely with healthcare providers and members to promote effective use of resources and ensure medically appropriate, high-quality, cost-effective care.

Responsibilities include conducting pre-certification, continued stay review, care coordination, or discharge planning for appropriateness of treatment setting reviews to ensure compliance with applicable criteria, medical policy, and member eligibility, benefits, and contracts.

You will work collaboratively with medical directors to interpret appropriateness of care and accurate claims payment. Additionally, you will consult with clinical reviewers and/or medical directors to ensure medically appropriate, high-quality, cost-effective care throughout the medical management process.

Our company offers a comprehensive compensation package, including a competitive salary range of $90,000 - $120,000 per annum, depending on experience, as well as opportunities for professional growth and development.



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