Medical Management Nurse

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

About This Role

The Medical Management Nurse at Elevance Health is responsible for reviewing complex cases that require nursing judgement and critical thinking to determine the medical necessity of requested services. This role is ideal for experienced nurses who excel in clinical assessment and collaboration with healthcare providers.

Highlights

• Location: Indianapolis, IN
• Schedule: Full-time, Virtual with in-person training sessions

What You’ll Do

• Review complex cases to determine medical necessity of services.
• Utilize nursing judgement to analyze members’ clinical information.
• Collaborate with healthcare providers to assess member clinical pictures.
• Provide consultation to the Medical Director on unclear cases.
• Act 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.
• Help train lower-level clinician staff.

Requirements

Education

• Associate’s degree in nursing required.

Experience

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

Licenses & Certifications

• Current active RN license required.
• Multi-state licensure required if providing services in multiple states.

Benefits

• Merit increases and incentive bonus programs.
• Paid holidays and Paid Time Off.
• Medical, dental, and vision benefits.
• 401(k) with match and stock purchase plan.
• Life insurance and wellness programs.

About Elevance Health

Elevance Health is a health company dedicated to improving lives and communities – and making healthcare simpler. They are a Fortune 25 company with a longstanding history in the healthcare industry, looking for leaders at all levels who are passionate about making an impact on their members and the communities they serve.