Job Information
Elevance Health Manager II – Medical Management – RN – Grievances & Appeals in PALO ALTO, California
Manager II - Medical Management – RN – Grievances & Appeals
Location: This position will work a hybrid model (remote and office). The ideal candidate will live within 50 miles of one of our Elevance Health PulsePoint locations in California as listed in the requisition.
Work Schedule: M-F with rotation for Saturday.
Manager II - Medical Management - RN - Grievances & Appeals 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.
Manages areas which 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.
Serves as mentor to lower leveled managers and as subject matter expert for other areas of the company and within the department.
Manages multiple functions requiring unique sets of knowledge or has significant fiscal accountability.
Develops and manages annual operating budget.
Hires, trains, coaches, counsels, and evaluates performance of direct reports.
Minimum Requirements:
Requires minimum of 5 years acute care clinical experience which includes a minimum of 2 years prior management experience; or any combination of education and experience, which would provide an equivalent background.
Current active unrestricted RN license from the State of California required.
Preferred Skills, Capabilities and Experiences:
BS preferred.
Healthcare insurance experience highly preferred.
Prior experience in Grievances & Appeals highly preferred.
Experience leading production-based teams highly preferred.
Experience leading clinical staff.
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.
For candidates working in person or remotely in the below location(s), the salary* range for this specific position is $112,240 to $183,000.
Locations: California
In addition to your salary, Elevance Health offers benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). The salary offered for this specific position is based on a number of legitimate, non-discriminatory factors set by the Company. The Company is fully committed to ensuring equal pay opportunities for equal work regardless of gender, race, or any other category protected by federal, state, and local pay equity laws .
- The salary range is the range Elevance Health in good faith believes is the range of possible compensation for this role at the time of this posting. This range may be modified in the future and actual compensation may vary from posting based on geographic location, work experience, education and/or skill level. Even within the range, the actual compensation will vary depending on the above factors as well as market/business considerations. No amount is considered to be wages or compensation until such amount is earned, vested, and determinable under the terms and conditions of the applicable policies and plans. The amount and availability of any bonus, commission, benefits, or any other form of compensation and benefits that are allocable to a particular employee remains in the Company's sole discretion unless and until paid and may be modified at the Company’s sole discretion, consistent with the law.