Care Management RN — Virtual Case Review Expert

Elevance Health; Indiana; Hybrid; USD 70,000 - 95,000; Full time

Benefits offered by this job

Merit increases

Incentive bonus programs

Paid holidays

Paid Time Off

Medical, dental, and vision benefits

401(k) with match

Stock purchase plan

Life insurance

Wellness programs

Job summary

Elevance Health is seeking a Medical Management Nurse in Indianapolis, IN. The role requires reviewing complex cases to determine medical necessity, using nursing judgement and collaborating with healthcare providers to assess member clinical pictures.

The ideal candidate has 4+ years in care/case management, 2+ years in clinical/utilization review, and an active RN license with multi-state licensure. The position is full-time andVirtual with in-person training sessions.

Qualifications

• 4+ years in care management or case management.
• 2+ years in clinical, utilization review, or managed care.

Responsibilities

• Review complex cases to determine medical necessity of services.
• Analyze members’ clinical information using nursing judgement.
• Collaborate with healthcare providers to assess member clinical pictures.
• Provide consultation to the Medical Director on unclear cases.
• Serve as a resource for lower-level nurses.
• Participate in special projects and process improvement initiatives.
• Educate members about plan benefits and assist with case management.
• Collaborate with case management nurses on discharge planning.
• Complete quality audits and assist management with corrective action plans.
• Assist training of lower-level clinician staff.

Skills

Care management

Utilization review

Education

Associate’s degree in nursing

RN license

Multi-state licensure

Job description

Elevance Health is seeking a Medical Management Nurse in Indianapolis, IN. The role requires reviewing complex cases to determine medical necessity, using nursing judgement and collaborating with healthcare providers to assess member clinical pictures.

The ideal candidate has 4+ years in care/case management, 2+ years in clinical/utilization review, and an active RN license with multi-state licensure. The position is full-time andVirtual with in-person training sessions.