Remote Medical Management Nurse

Elevance Health; Decatur, Northern (GA, KY); Hybrid; USD 45,000 - 99,000; Full time

Benefits offered by this job

Benefits package

Job summary

Elevance Health is seeking a Medical Management Nurse with InterQual and ACMP experience. This role involves analyzing member health needs, evaluating medical necessity, and collaborating across care teams to optimize outcomes.

A valid RN license and multi-state eligibility are required, with remote work within 50 miles of a pulsepoint location in Georgia. Monday–Friday, 8am–5pm, contract-to-hire potential.

Qualifications

• Active RN license in at least one US state
• GA or compact license required
• Minimum 4 years care/case management experience
• Minimum 2 years in clinical, utilization review, or managed care
• Multi-state licensure is required if serving multiple states

Responsibilities

• Analyze member needs using nursing judgment and clinical guidelines
• Assess medical necessity and interface with providers
• Promote quality outcomes and appropriate use of resources
• Collaborate with case management on discharge planning
• Provide nursing consultation to Medical Director on complex cases
• Educate members about plan benefits and care options

Skills

RN license

care management experience

clinical/utilization review

multi-state licensure

Education

Nursing degree

Tools

InterQual

ACMP

Job description

Elevance Health is seeking a Medical Management Nurse with InterQual and ACMP experience. This role involves analyzing member health needs, evaluating medical necessity, and collaborating across care teams to optimize outcomes.

A valid RN license and multi-state eligibility are required, with remote work within 50 miles of a pulsepoint location in Georgia. Monday–Friday, 8am–5pm, contract-to-hire potential.