Medical Management Clinician Associate

Elevance Health

. Review clinical information and assess medical necessity under relevant guidelines and/or medical policies .

Posted 11/6/2026full-timeTampa • Florida • United StatesJuniorMid-LevelWebsite

Core Competencies

Role fit

Core Competencies

Use this summary to align your resume positioning with the role.

Demonstrates expertise in clinical assessment and utilization review, ensuring compliance with medical policies and benefit plans. Holds a valid nursing license and possesses strong analytical skills to evaluate medical necessity and process determinations.

Highest-signal resume keywords

Clinical ExperienceUtilization Review ExperienceLPN/LVN or RN LicenseLTSS ExperienceMedical Necessity Assessment

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Clinical AssessmentMedical Necessity ReviewPrecertification ReviewConcurrent ReviewRetrospective ReviewAlgorithmic ProcessesBenefit Plan AdministrationDenial Determination ProcessingTreatment Setting Appropriateness ReviewContract Review

Certifications & Qualifications

LPN LicenseLVN LicenseRN License

Industry Keywords

Medical PoliciesClinical GuidelinesBenefit PlansUtilization ManagementMulti-State LicensureCOVID-19 VaccinationInfluenza Vaccination

About the role

Key responsibilities & impact

Review clinical information and assess medical necessity under relevant guidelines and/or medical policies
Ensure appropriate, consistent administration of plan benefits
Confirm medical services are appropriate based on assigned benefit plans, medical policies, clinical guidelines, plan benefits, and/or scripted algorithms within scope of licensure
Handle less complex benefit plans and/or contracts
Conduct and potentially approve precertification, concurrent, retrospective, out-of-network, and/or appropriateness-of-treatment-setting reviews
Assess clinical information against applicable medical policies, clinical guidelines, and relevant benefit plans/contracts
Process medical necessity denial determinations made by a Medical Director
Refer complex or non-routine reviews to senior nurses and/or Medical Directors
Work with algorithmic or automated processes where applicable
Do not issue medical necessity non-certifications

Requirements

What you’ll need

Reside in the state of Florida
Reside within a reasonable commuting distance from the posting location(s), unless an accommodation is granted as required by law
High school diploma or equivalent
Minimum of 2 years of clinical experience and/or utilization review experience
Current active, valid and unrestricted LPN/LVN or RN license and/or certification to practice as a health professional within the scope of licensure in applicable state(s) or territory of the United States
Multi-state licensure required if providing services in multiple states
LTSS or Utilization Management experience strongly preferred
Ability to work 8:00 am–5:00 pm, 4 days Monday through Friday and 1 weekend day, for 5 days per work week
COVID-19 and Influenza vaccination required for certain patient/member-facing roles, unless an acceptable explanation is provided

Benefits

Comp & perks

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 employer match
Stock purchase plan
Life insurance
Wellness programs
Financial education resources
Virtual full-time work, except for required in-person training sessions
Work-life integration and flexible autonomy