Medical Management Nurse (RN)

Elevance Health; Indiana; Remote; USD 85,000 - 110,000; Full time

Benefits offered by this job

Merit increases and incentive bonus

Paid holidays and PTO

Medical, dental, and vision

Short and long-term disability

401(k) with match and stock purchase

Life insurance and wellness programs

Job summary

Elevance Health is seeking a Medical Management Nurse (RN) for a fully remote, full-time role in the Indianapolis, IN area. You will apply nursing judgment to review complex cases for medical necessity, collaborate with providers, and advise the Medical Director on unclear cases.

You will also educate members about plan benefits, assist with case management, and contribute to discharge planning and quality initiatives. Active RN licensure and 4+ years in care/case management are required.

Qualifications

• Associate degree in nursing required.
• 4+ years in care management or case management.
• 2+ years in clinical, utilization review, or managed care.
• Current active RN license in applicable state(s).
• Multi-state licensure if providing services in multiple states.
• Strong nursing judgment and collaboration with providers.

Responsibilities

• Review complex cases to determine medical necessity of services.
• Utilize nursing judgment to assess members' clinical presentations.
• Consult with healthcare providers to understand members' clinical pictures.
• Provide consultation to Medical Director on unclear cases.
• Collaborate with case management nurses on discharge planning.
• Educate members about plan benefits and assist with case management.
• Participate in process improvement initiatives and quality audits.
• Serve as a resource for lower-level nurses and assist in their training.
• Work on special projects to improve organizational policies.

Skills

Care management

Case management

Clinical assessment

Collaboration with providers

Nursing judgment

Education

Associate's degree in nursing

Job description

About This Role

The Medical Management Nurse (RN) is responsible for reviewing complex cases requiring nursing judgment 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

What You'll Do

• Review complex cases to determine medical necessity of services.
• Utilize nursing judgment to assess members' clinical presentations.
• Consult with healthcare providers to understand members' clinical pictures.
• Provide consultation to Medical Director on unclear cases.
• Collaborate with case management nurses on discharge planning.
• Educate members about plan benefits and assist with case management.
• Participate in process improvement initiatives and quality audits.
• Serve as a resource for lower-level nurses and assist in their training.
• Work on special projects to improve organizational policies.

Requirements

• Education: Associate’s degree in nursing required.
• Experience:
  • Minimum of 4 years in care management or case management.
  • Minimum of 2 years in clinical, utilization review, or managed care.
• 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.
• Short and long-term disability 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 while making healthcare simpler. As a Fortune 25 company, they are committed to delivering exceptional care and are looking for passionate leaders at all levels to make an impact on their members and communities.