Manager I Medical Mgmt

Elevance Health•St. Louis, MO

3d•$108,100 - $162,150•Hybrid

About The Position

Manager I Medical Mgmt Location: This role requires associates to be in-office 3 days per week, fostering collaboration and connectivity, while providing flexibility to support productivity and work-life balance. This approach combines structured office engagement with the autonomy of virtual work, promoting a dynamic and adaptable workplace. Alternate locations may be considered if candidates reside within a commuting distance from an office Please note that per our policy on hybrid/virtual work, candidates not within a reasonable commuting distance from the posting location(s) will not be considered for employment, unless an accommodation is granted as required by law. Wellpoint Federal, a subsidiary of Elevance Health, brings deep industry expertise and healthcare service capabilities to support federal programs. The organization delivers solutions across claims administration, data, and care delivery to help address complex challenges and improve health outcomes for federal populations. The Manager I Medical Mgmt is responsible to manage a team of clinicians charged with promoting quality member outcomes, to optimize member benefits, and to promote effective use of resources How you will make an impact: 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, outpatient services, home health 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.

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.
This position is part of our Wellpoint Federal division which, per CMS TDL 190275, requires foreign national applicants meet the residency requirement of living in the United States at least three of the past five years.

Nice To Haves

Strong oral, written and interpersonal communication skills, problem-solving skills, facilitation skills, and analytical skills strongly preferred.
If this job is assigned to any Government Business Division entity, the applicant and incumbent fall under a `sensitive position' work designation and may be subject to additional requirements beyond those associates outside Government Business Divisions. Requirements include but are not limited to more stringent and frequent background checks and/or government clearances, segregation of duties principles, role specific training, monitoring of daily job functions, and sensitive data handling instructions. Associates in these jobs must follow the specific policies, procedures, guidelines, etc. as stated by the Government Business Division in which they are employed.

Responsibilities

Manage a team of clinicians charged with promoting quality member outcomes, to optimize member benefits, and to promote effective use of resources
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, outpatient services, home health 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.