Manager II, Medical Management – Grievance and Appeals, RN

Elevance Health

. Manage a team of clinicians promoting quality member outcomes, optimizing member benefits, and promoting effective resource use .

Posted 11/2/2026full-timeUnited StatesMid-LevelSenior💰 $102,400 - $184,320 per yearWebsite

Core Competencies

Role fit

Core Competencies

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Demonstrates expertise in managing clinical teams to optimize member outcomes and resource utilization while ensuring adherence to medical policies and high-quality service delivery. Proficient in care coordination, budget management, and mentoring, with a strong focus on problem-solving and communication skills.

Highest-signal resume keywords

California RN LicenseAcute Care Clinical ExperienceManagement ExperienceTrauma or ER Nursing ExperienceHealth Plan Experience

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Care CoordinationBudget ManagementAuthorization ManagementClinical Policy InterpretationInventory ManagementAppeals ManagementResource OptimizationQuality AssuranceCost-Effective Service DeliveryMember Benefit Management

Soft Skills

Interpersonal CommunicationProblem-SolvingAnalytical SkillsFacilitation SkillsFlexibility

Certifications & Qualifications

California RN LicenseHS Diploma or Equivalent

Industry Keywords

Managed CareDMHC ExperienceAcute CareClinical NursingHealth Plan

About the role

Key responsibilities & impact

Manage a team of clinicians promoting quality member outcomes, optimizing member benefits, and promoting effective resource use
Ensure adherence to medical policy and member benefits while providing medically appropriate, high-quality, cost-effective service
Manage authorization of inpatient admissions, outpatient services, focused surgical and diagnostic procedures, out-of-network services, and treatment-setting appropriateness
Interpret medical policies, industry standards, benefits, and managed care products
Steer members to appropriate providers, programs, or community resources
Apply clinical knowledge to collaborate with facilities and providers on care coordination
Manage appeals for denied services
Mentor lower-level managers and serve as a subject matter expert
Manage multiple functions requiring specialized knowledge or significant fiscal accountability
Develop and manage the annual operating budget
Hire, train, coach, counsel, and evaluate direct reports
Provide Monday-Friday coverage from 8:30-5 PST, rotating Saturday on-call coverage approximately once every four weeks, and federal holiday coverage

Requirements

What you’ll need

HS diploma or equivalent required
Minimum of 5 years acute care clinical experience
Minimum of 2 years prior management experience
Current, active, valid unrestricted California RN license required
BS preferred
Trauma or ER clinical nursing experience strongly preferred
Fast-paced production environment experience
Oversight of inventory management experience strongly preferred
Previous health plan experience strongly preferred
California Department of Managed Health Care (DMHC) experience preferred
Strong oral, written, and interpersonal communication skills
Problem-solving skills
Facilitation skills
Analytical skills
Flexibility for appropriate team coverage as needed
Candidates must be within a reasonable commuting distance from the posting location(s), unless accommodation is granted as required by law
Candidates in certain patient/member-facing roles must become vaccinated against COVID-19 and Influenza, unless an acceptable explanation is provided

Benefits

Comp & perks

Comprehensive benefits package
Incentive and recognition programs
Equity stock purchase
401(k) contribution
Merit increases
Paid holidays
Paid Time Off
Incentive bonus programs
Medical benefits
Dental benefits
Vision benefits
Short-term disability benefits
Long-term disability benefits
401(k) with match
Stock purchase plan
Life insurance
Wellness programs
Financial education resources
Hybrid work flexibility
Professional and personal growth opportunities