Remote Clinical Case Management Nurse

Elevance Health; Las Vegas (NV); Remote; USD 53,000 - 79,000; Full time

Benefits offered by this job

Hybrid/virtual work

Vaccination policy

Equal Employment Opportunity

Job summary

Elevance Health is seeking a Medical Management Nurse for virtual full-time work with occasional required in-person training. The role emphasizes nursing judgment, holistic assessment, and collaboration with providers to determine medical necessity and promote quality member outcomes.

The position requires an associate degree in nursing, active RN license, and 4+ years in care/case management with 2+ years in clinical/utilization review.

Qualifications

• Requires an associate’s degree in nursing and an active RN license.
• Minimum 4 years care management or case management experience and at least 2 years clinical, utilization review, or managed care experience.

Responsibilities

• Reviews complex cases to determine medical necessity.
• Collaborates with healthcare providers to assess clinical pictures and apply guidelines.
• Provides consultation to Medical Director on unclear or complex cases.

Skills

Nursing judgment

Critical thinking

Holistic assessment

Education

Associate’s degree in nursing

Job description

Elevance Health is seeking a Medical Management Nurse for virtual full-time work with occasional required in-person training. The role emphasizes nursing judgment, holistic assessment, and collaboration with providers to determine medical necessity and promote quality member outcomes.

The position requires an associate degree in nursing, active RN license, and 4+ years in care/case management with 2+ years in clinical/utilization review.