Medical Management Clinician Senior (RN)

FL-MIAMI, 11430 NW 20TH ST, STE 200 & 300senior
OperationsManagement
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Quick Summary

Requirements Summary

Requires H.S. diploma or equivalent. Requires a minimum of 6 years of clinical experience and/or utilization review experience. Current active,

Technical Tools
OperationsManagement

2026-10-13

Medical Management Clinician Senior (RN)


What We Offer

~2 min read

Primary duties may include, but are not limited to:

✓Responsible for complex cases that may require evaluation of multiple variables against guidelines when procedures are not clear.
✓Serves as a resource to lower-level clinicians and staff.
✓May collaborate with leadership to assist in process improvement initiatives to improve the efficiency and effectiveness of the utilization reviews within the medical management processes.
✓Assesses and applies medical policies and clinical guidelines within scope of licensure.
✓These reviews may require in-depth review; however, any deviation from application of benefits plans will require guidance from leadership, medical directors or delegated clinical staff.
✓Conducts and may approve pre-certification, concurrent, retrospective, out of network and/or appropriateness of treatment setting reviews by utilizing appropriate medical policies and clinical guidelines in compliance with department guidelines and consistent with the members eligibility, benefits and contract.
✓May process a medical necessity denial determination made by a Medical Director.
✓Develops and fosters ongoing relationships with physicians, healthcare service providers and internal and external customers to help improve health outcomes for members.
✓Refers complex or unclear reviews to higher level nurses and/or Medical Directors.
✓Educates members about plan benefits and physicians.
✓Does not issue medical necessity non-certifications.
✓Collaborates with leadership in enhancing training and orientation materials.
✓May complete quality audits and assist management with developing associated corrective action plans.
✓May assist leadership and other stakeholders on process improvement initiatives.
✓May help to train lower-level clinician staff.

Requirements

~1 min read
  • Requires H.S. diploma or equivalent.
  • Requires a minimum of 6 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 required.
  • Multi-state licensure is required if this individual is providing services in multiple states.

Nice to Have

~1 min read
  • Fully Bilingual (English & Spanish), Must be able to write, read and speak both languages in a proficiency level preferred.
  • Computer proficiency and experience using Microsoft Office and other business systems are strongly preferred.

Non-Management Non-Exempt

MED > Licensed Nurse

Please be advised that Elevance Health only accepts resumes for compensation from agencies that have a signed agreement with Elevance Health. Any unsolicited resumes, including those submitted to hiring managers, are deemed to be the property of Elevance Health.


Elevance Health is a health company dedicated to improving lives and communities – and making healthcare simpler. We are a Fortune 25 company with a longstanding history in the healthcare industry, looking for leaders at all levels of the organization who are passionate about making an impact on our members and the communities we serve.


At Elevance Health, we are creating a culture that is designed to advance our strategy but will also lead to personal and professional growth for our associates. Our values and behaviors are the root of our culture. They are how we achieve our strategy, power our business outcomes and drive our shared success - for our consumers, our associates, our communities and our business.


We offer a range of market-competitive total rewards that include merit increases, paid holidays, Paid Time Off, and incentive bonus programs (unless covered by a collective bargaining agreement), medical, dental, vision, short and long term disability benefits, 401(k) +match, stock purchase plan, life insurance, wellness programs and financial education resources, to name a few.


Elevance Health operates in a Hybrid Workforce Strategy. Unless specified as primarily virtual by the hiring manager, associates are required to work at an Elevance Health location at least once per week, and potentially several times per week. Specific requirements and expectations for time onsite will be discussed as part of the hiring process.


The health of our associates and communities is a top priority for Elevance Health. We require all new candidates in certain patient/member-facing roles to become vaccinated against COVID-19 and Influenza. If you are not vaccinated, your offer will be rescinded unless you provide an acceptable explanation. Elevance Health will also follow all relevant federal, state and local laws.


Elevance Health is an Equal Employment Opportunity employer, and all qualified applicants will receive consideration for employment without regard to age, citizenship status, color, creed, disability, ethnicity, genetic information, gender (including gender identity and gender expression), marital status, national origin, race, religion, sex, sexual orientation, veteran status or any other status or condition protected by applicable federal, state, or local laws. Applicants who require accommodation to participate in the job application process should submit the following form: Accessibility Accommodation Request Form and a member of the team will be in contact. Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state, and local laws, including, but not limited to, the Los Angeles County Fair Chance Ordinance and the California Fair Chance Act.


Prospective employees required to be screened under Florida law should review the education and awareness resources at HB531 | Florida Agency for Health Care Administration.


NOTE: Workday keeps job postings active through 11:59:59 PM on the day before the listed end date. Example: If the end date is 3/13, the posting will automatically come down on 3/12 at 11:59:59 PM. In other words — the job is posted until 3/13, not through 3/13.

Location & Eligibility

Where is the job
Not specified
Location terms not specified
Who can apply
Same as job location

About this job

Posted
17 days ago
Employer
has 556 open jobs on Jobera.

Listing Details

Posted
September 29, 2026
First seen
September 30, 2026
Last seen
October 12, 2026

Posting Health

Days active
16
Repost count
0
Trust Level
23%
Scored at
October 16, 2026

Signal breakdown

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Medical Management Clinician Senior (RN)