Medical Management Clinician Senior

Anticipated End Date: 2026-11-03 Position Title: Medical Management Clinician Senior (RN) Job Description - Location: 11430 NW 20th St, Ste 200 & 300, Miami - FL - Virtual: This role enables associates to work virtually full-time, except for required in-person training sessions, providing maximum flexibility and autonomy. This approach promotes productivity, supports work-life integration, and ensures essential face-to-face onboarding and skill development. - 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. - Schedule: This position will work an 8-hour shifts between 8:00 am - 5:00 pm (EST), Monday through Friday. Additional hours, including weekends or holidays, may be required based on operational needs. - Founded in 2005, and now a proud member of the Elevance Health family of companies, HealthSun is a local Medicare Managed Care Organization with administrative offices located in Coconut Grove, Florida. - Serving more than 50,000 members, HealthSun is one of the fastest growing health plans in South Florida. - As a local plan, we recognize the healthcare needs of our community and strive to provide our members with only the best service and experience possible. - The Medical Management Clinician Senior is responsible for ensuring appropriate, consistent administration of plan benefits by reviewing clinical information and assessing medical necessity under relevant guidelines and/or medical policies. May collaborate with healthcare providers. Acts as a resource for more junior Clinicians. How You Will Make an Impact - Primary duties may include, but are not