Manager II Medical Management

Anticipated End Date:

2026-01-30

Position Title:

Manager II Medical Management

Job Description:

Manager II Medical Management

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. Ideal candidates will be able to report to one of our Pulse Point locations in California, Colorado, or Nevada.

The Manager II Medical Management will be responsible for managing a team of clinicians charged with promoting quality member outcomes, optimizing member benefits, and promoting 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 a HS diploma or equivalent and a 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, valid unrestricted RN license to practice as a health professional within the scope of licensure in applicable state(s) or territory of the United States required, except in government business where it is preferred.

Preferred Skills, Capabilities, and Experiences:

• BS preferred.
• MS Office Suite experience preferred.
• Health plan experience preferred.
• Management experience preferred.
• Production environment experience preferred.
• Clinical experience in an ER/trauma unit preferred.
• Effective verbal and written communication skills, with the ability to convey complex information clearly and persuasively to diverse audiences strongly preferred.
• 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.

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. Required to follow the specific policies, procedures, guidelines, etc. as stated by the Government Business Division in which the associate is employed.

For candidates working in person or virtually in the below location(s), the salary* range for this specific position is $105,084 to $180,144.

Locations: California, Colorado, Nevada

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 th