Manager I - Clinical Solutions Manager

Elevance Health • Tampa, FL

5d • $94,000 - $162,150 • Hybrid

About The Position

The Manager I - Clinical Solutions Manager leads a team of clinical and non-clinical staff responsible for managing work after physician review. This role ensures that complex cases are handled accurately, on time, and in accordance with company policies and regulatory requirements. The manager works closely with physician reviewers, the Provider Network team, Client Services and other departments to ensure cases move efficiently through the review process and that providers and members receive timely, high-quality service. The Manager I - Clinical Solutions Manager also researches and resolves complex escalated cases that require quick turnaround. This role partners with physicians and other internal teams to remove barriers, improve workflows, solve operational issues, and support better outcomes for providers, members, and the organization.

Requirements

• Requires a HS diploma or equivalent and a minimum of 5 years acute care clinical experience; or any combination of education and experience, which would provide an equivalent background.
• Requires current, active, valid unrestricted RN license to practice as a health professional within the scope of practice in applicable state(s) or territory of the United States.

Nice To Haves

• Strong oral, written and interpersonal communication skills, problem-solving skills, facilitation skills, and analytical skills strongly preferred.
• Strong leadership skills, including coaching, performance management, and development of direct reports.
• Experience managing complex escalations and driving timely issue resolution.
• Strong collaboration skills with physicians, providers, and cross-functional business partners.
• Knowledge of medical policy interpretation, utilization management, and care coordination processes.
• Strong decision-making, prioritization, communication, and analytical skills.
• For URAC accredited areas, the following professional competencies apply: Associates in this role are expected to have strong oral, written and interpersonal communication skills, problem-solving skills, facilitation skills, and analytical skills.

Responsibilities

• Ensures adherence to medical policy and member benefits in providing service that is medically appropriate, high quality, and cost effective.
• Areas managed may include authorizing inpatient admissions, outpatient services, focused surgical and diagnostic procedures, out of network services, and appropriateness of treatment setting by utilizing the applicable medical policy and industry standards, accurately interpreting benefits and managed care products, and steering members to appropriate providers, programs or community resources.
• Applies clinical knowledge to work with facilities and providers for care-coordination.
• May also manage appeals for services denied.
• Hires, trains, coaches, counsels, and evaluates performance of direct reports.

Benefits

• comprehensive benefits package
• incentive and recognition programs
• equity stock purchase
• 401k contribution
• merit increases
• paid holidays
• Paid Time Off
• incentive bonus programs
• medical, dental, vision
• short and long term disability benefits
• 401(k) +match
• stock purchase plan
• life insurance
• wellness programs
• financial education resources

What This Job Offers

• Job Type: Full-time
• Career Level: Manager
• Education Level: High school or GED