Medical Management Clinician
Elevance Health
Posted: 10/21/2026
Adolescent Behavioral Health & Addiction Clinician
Carle Health
Posted: 10/21/2026
Care Management Clinician
Cambia Health Solutions
Posted: 10/21/2026LTSS Service Coordinator – Clinician
Elevance Health
Posted: 10/21/2026
Part Time Behavioral Health Assessment Clinician – Texas Licensed
UCSF Pediatrics
Posted: 10/20/2026
Master's Level SUD Clinician
Paragon Behavioral Health Connections
Posted: 10/20/2026
Senior Behavioral Health Integration Clinician, Clinical Excellence Lead
Mindoula
Posted: 10/20/2026
Certified Prosthetist/Orthotist Clinician
Hanger, Inc.
Posted: 10/20/2026
Clinician Scheduler
US Acute Care Solutions
Posted: 10/20/2026Prosthetist and/or Orthotist Clinician – Board Eligible
Hanger, Inc.
Posted: 10/20/2026
Crisis Clinician, Emergency Services
Beth Israel Lahey Health
Posted: 10/20/2026Crisis Clinician, Emergency Services
Beth Israel Lahey Health
Posted: 10/20/2026
Respiratory Clinician
UMass Memorial Health
Posted: 10/20/2026
Crisis Clinician, Thurs-Sat 3pm-3am
HealthSource Integrated Solutions
Posted: 10/20/2026
Crisis Services Clinician
Crisis Connections
Posted: 10/20/2026
Family Support and Stabilization Clinician
Children's Services of Roxbury, Inc.
Posted: 10/20/2026
Fee-for-Service Clinician
Mental Health Association
Posted: 10/20/2026Mental Health and Developmental Clinician
Paragon Behavioral Health Connections
Posted: 10/19/2026Crisis Stabilization Clinician
Paragon Behavioral Health Connections
Posted: 10/19/2026Child and Family Clinician
Paragon Behavioral Health Connections
Posted: 10/19/2026Medical Management Clinician
Elevance HealthCore Competencies
Role fitCore Competencies
Use this summary to align your resume positioning with the role.
Demonstrates expertise in clinical assessment and utilization review, ensuring adherence to medical necessity guidelines and effective communication with healthcare providers. Proficient in evaluating complex cases and educating members about plan benefits.
Highest-signal resume keywords
Clinical ExperienceUtilization Review ExperienceRegistered Nurse LicenseMedical Necessity AssessmentPatient Education
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
- Evaluate moderately complex cases involving multiple variables against guidelines
- Handle moderately complex benefit plans and/or contracts
- Conduct and may approve precertification, concurrent, retrospective, out-of-network, and/or appropriateness of treatment setting reviews
- Process medical necessity denial determinations made by a Medical Director
- Work directly with healthcare providers to obtain and understand clinical information
- Refer complex or unclear reviews to higher-level nurses and/or Medical Directors
- Serve as a resource to less experienced staff
- Educate members about plan benefits and physicians
- Work may be facilitated by algorithmic or automated processes
- Does not issue medical necessity non-certifications
Requirements
What you’ll need- H.S. diploma or equivalent
- Minimum of 4 years of clinical experience and/or utilization review experience
- Current active, valid and unrestricted LPN/LVN license 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
- An active Registered Nurse License is strongly preferred
- Ability to work 8:00 am–5:00 pm EST, Monday to Friday
- Candidates must be within a reasonable commuting distance from the posting location(s), unless an accommodation is granted as required by law
- New candidates in certain patient/member-facing roles must become vaccinated against COVID-19 and Influenza, 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) + match
- Stock purchase plan
- Life insurance
- Wellness programs
- Financial education resources
- Virtual full-time work flexibility, except for required in-person training sessions
ATS Keywords
✓ Tailor your resumeApplicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills
Clinical AssessmentUtilization ReviewMedical Necessity DeterminationPrecertification ReviewConcurrent ReviewRetrospective ReviewOut-Of-Network ReviewBenefit Plan EvaluationAlgorithmic ProcessesCase Evaluation
Soft Skills
CommunicationCollaborationResourcefulnessMentoringProblem-Solving
Certifications & Qualifications
LPN LicenseLVN LicenseRN License
Industry Keywords
HealthcareMedical PoliciesPlan BenefitsClinical InformationPatient CareCOVID-19 VaccinationInfluenza VaccinationMulti-State LicensureModerately Complex CasesTreatment Setting Reviews