Anticipated End Date:
2026-11-20
Position Title:
Manager II Medical Management, Grievance and Appeals CA RN required
Job Description:
Manager II Medical Management, Grievance and Appeals CA RN required
Anticipated job Posting End Date: 11/13/2026
Location: California, Colorado, or Nevada
Hybrid 2: 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.
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 accommodation is granted as required by law.
Work Hours: Monday – Friday 8:30-5 PST. This job does require on call coverage in rotation for Saturday’s, usually 1 Saturday 8:30-5 PST every 4 weeks, as well as federal holiday coverage. Flexibility required for appropriate team coverage as needed.
The Manager II Medical Management 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 Qualifications:
- 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 California RN license is required.
Preferred Skills, Capabilities and Experiences:
- BS preferred.
- Trauma or ER clinical nursing experience is strongly preferred.
- Fast paced production environment, oversight of inventory management experience strongly preferred.
- Previous health plan experience strongly preferred.
- California Department of Managed Health Care (DMHC) experience preferred.
- 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 virtually in the below locations, the salary* range for this specific position is $102,400 to $184,320
- Location(s): 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 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 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.
Job Level:
Manager
Workshift:
Job Family:
MED > Licensed Nurse
Please be advised that Elevance Health only accepts resumes for compensation from agencies that have a signed agreement with Elevance Health. Any unsolicited resumes, including those submitted to hiring managers, are deemed to be the property of Elevance Health.
