Manager Medical Management at Elevance Health

Taguig, Metro Manila, Philippines

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Not SpecifiedCompensation

Senior (5 to 8 years)Experience Level

Full TimeJob Type

UnknownVisa

Healthcare, Health InsuranceIndustries

Requirements

Current active unrestricted RN license to practice as a health professional within the scope of practice in applicable state(s) or territory of the United States (except preferred in government business)
5 years acute care clinical experience or any combination of education and experience providing an equivalent background
Strong oral, written, and interpersonal communication skills
Strong problem-solving skills
Strong facilitation skills
Strong analytical skills

Responsibilities

Manage a team of clinicians charged with promoting quality member outcomes, optimizing member benefits, and promoting effective use of resources
Ensure adherence to medical policy and member benefits in providing service that is medically appropriate, high quality, and cost effective
Authorize inpatient admissions, outpatient services, focused surgical and diagnostic procedures, out-of-network services, and appropriateness of treatment setting by utilizing applicable medical policy and industry standards
Accurately interpret benefits and managed care products
Steer members to appropriate providers, programs, or community resources
Apply clinical knowledge to work with facilities and providers for care-coordination
Manage appeals for services denied
Hire, train, coach, counsel, and evaluate performance of direct reports

Skills

Key technologies and capabilities for this role

RN LicenseAcute CareMedical PolicyUtilization ReviewCare CoordinationAppeals ManagementTeam ManagementCommunication SkillsProblem-SolvingAnalytical SkillsFacilitation

Questions & Answers

Common questions about this position

What license and experience are required for the Manager Medical Management role?

A current active unrestricted RN license is required to practice as a health professional in applicable state(s) or territory, plus 5 years of acute care clinical experience or equivalent.

What key skills are needed for this position?

Strong oral, written and interpersonal communication skills, problem-solving skills, facilitation skills, and analytical skills are required.

What does the Manager Medical Management role entail in terms of team responsibilities?

The role involves managing a team of clinicians, including hiring, training, coaching, counseling, and evaluating performance of direct reports.

Is this a remote position or does it require specific location?

This information is not specified in the job description.

What is the salary or compensation for this role?

This information is not specified in the job description.

Elevance Health

Integrated health services and digital platform

About Elevance Health

Elevance Health focuses on enhancing the health of individuals throughout their lives by evolving from a traditional health benefits organization into a comprehensive health partner. The company serves over 118 million people, providing support at every stage of health through an integrated approach that addresses a wide range of health needs. Their services are backed by advanced capabilities and a digital health platform that streamlines access to care. Unlike many competitors, Elevance Health emphasizes a holistic view of health, aiming to redefine health and improve community well-being. The ultimate goal is to make health improvements accessible to everyone.

Indianapolis, IndianaHeadquarters

1944Year Founded

$309.4MTotal Funding

IPOCompany Stage

Enterprise Software, Social Impact, HealthcareIndustries

10,001+Employees

Benefits

Medical, dental, & vision insurance

401(k) + match

Paid holidays

Paid Time Off

Incentive bonus programs

Stock purchase plan

Life insurance

Wellness Programs

Financial education resources

Adoption & Surrogacy Assistance

Dependent-care Flexible Spending Account (DCFSA)

Parental Leave

Parental Transition Week

Critical Caregiving Leave

Risks

Departure of CFO John Gallina may create a gap in financial leadership.

Lawsuit against CMS over MA Star Ratings could lead to financial penalties.

CareBridge integration may face operational challenges, disrupting service delivery.

Differentiation

Elevance Health integrates whole health approach with digital health platform for comprehensive care.

Acquisition of CareBridge enhances home health services within Carelon division.

Strategic partnership with Clayton, Dubilier & Rice aims to innovate primary care delivery.

Upsides

AI integration in home health services can reduce hospital readmissions and improve outcomes.

Predictive analytics support early disease detection, aligning with Elevance's whole health approach.

Telehealth expansion offers opportunities to reach more patients remotely.

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