Medical Management Nurse - AmeriBen

Elevance Health; Iowa; On-site; USD 85,000 - 110,000; Full time

Benefits offered by this job

Merit increases and incentive bonus

Paid holidays and Paid Time Off

Medical, dental, and vision benefits

401(k) with match and stock purchase

Life insurance and wellness programs

Job summary

Elevance Health in Urbandale, IA seeks a Medical Management Nurse - AmeriBen to review complex cases and determine medical necessity. You’ll collaborate with providers, support case management, and educate members on plan benefits. This full-time role requires strong nursing judgment and utilization review experience.

Join a Fortune 25 health company focused on improving lives and communities, with opportunities to impact member outcomes and contribute to process improvements.

Qualifications

• Associate’s degree in nursing required.
• Minimum of 4 years care management or case management experience.
• Minimum of 2 years clinical, utilization review, or managed care experience.
• Current active RN license in applicable state(s) required.
• Multi-state licensure required if providing services in multiple states.

Responsibilities

• Analyze members’ clinical information and interface with healthcare providers.
• Assess clinical presentations and apply clinical guidelines to evaluate medical necessity.
• Promote quality member outcomes and optimize member benefits.
• Recognize when a member may not be receiving appropriate care.
• Provide consultation to the Medical Director on complex cases.
• Collaborate with case management nurses on discharge planning.
• Serve as a resource for lower-level nurses.
• Participate in process improvement initiatives and projects.
• Educate members about plan benefits and assist with case management.
• Complete quality audits and assist management with corrective action plans.

Skills

Case management

Nursing expertise

Clinical decision making

Interdisciplinary collaboration

Education

Associate’s degree in nursing

Job description

About This Role

The Medical Management Nurse - AmeriBen is responsible for reviewing complex cases that require nursing judgment and critical thinking to determine the medical necessity of requested services. This role is ideal for experienced nurses who excel in case management and collaboration with healthcare providers.

Highlights

• Location: Urbandale, IA
• Schedule: Monday – Friday, 8am – 5pm MST

What You'll Do

• Analyze members’ clinical information and interface with healthcare providers.
• Assess clinical presentations and apply clinical guidelines to evaluate medical necessity.
• Promote quality member outcomes and optimize member benefits.
• Recognize when a member may not be receiving appropriate care.
• Provide consultation to the Medical Director on complex cases.
• Collaborate with case management nurses on discharge planning.
• Serve as a resource for lower-level nurses.
• Participate in process improvement initiatives and projects.
• Educate members about plan benefits and assist with case management.
• Complete quality audits and assist management with corrective action plans.

Requirements

Education:

• Associate’s degree in nursing required.

Experience:

• Minimum of 4 years care management or case management experience.
• Minimum of 2 years clinical, utilization review, or managed care experience.

Licenses & Certifications:

• Current active RN license in applicable state(s) 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.