Remote Med Management Nurse | RN, Case Management

The Elevance Health Companies, Inc.; Indianapolis (IN); Hybrid; USD 90,000 - 115,000; Full time

Benefits offered by this job

Health benefits

401(k) + match

Stock purchase plan

Merit increases

Paid holidays

Paid Time Off

Dental

Vision

Short and long term disability

Job summary

Elevance Health is seeking a Med Mgmt Nurse (US) to review complex cases, exercise nursing judgment, and advise on medical necessity within a hybrid virtual/onsite framework. The role supports the Medical Director and collaborates with clinicians to optimize member care.

Qualified candidates will hold an active RN license, with 4+ years in care management and 2+ years in clinical/utilization review. This position at Elevance Health offers a pathway to impact patient outcomes across the Federal

Qualifications

• Requires an RN license active and unrestricted.
• Minimum of 4 years care or case management experience.
• Minimum 2 years clinical, utilization review, or managed care experience.

Responsibilities

• Review complex cases to determine medical necessity.
• Collaborate with healthcare providers to assess clinical presentation.
• Provide consultation to the Medical Director on unclear or complex cases.
• Assist with policy development and process improvement initiatives.

Skills

RN license

Care management

Clinical assessment

Nursing judgment

Multistate licensure

Education

Associate's degree in nursing

Job description

Elevance Health is seeking a Med Mgmt Nurse (US) to review complex cases, exercise nursing judgment, and advise on medical necessity within a hybrid virtual/onsite framework. The role supports the Medical Director and collaborates with clinicians to optimize member care.

Qualified candidates will hold an active RN license, with 4+ years in care management and 2+ years in clinical/utilization review. This position at Elevance Health offers a pathway to impact patient outcomes across the Federal