Remote Medical Management Nurse (CA Licensed)

The Elevance Health Companies, Inc.; Los Angeles (CA); Hybrid; USD 84,000 - 144,000; Full time

Benefits offered by this job

Comprehensive benefits package

Incentive programs

Equity stock purchase

401(k) contribution

Job summary

Elevance Health is seeking a Medical Management Nurse (CA Licensed) to assess complex cases, determine medical necessity, and consult with the Medical Director on nuanced cases. The role supports providers, educates members on plan benefits, and helps shape policies through collaboration with case management teams.

Locations include Woodland Hills, Walnut Creek, Costa Mesa, and Las Vegas; virtual/full-time options are available with required in-person training sessions and California overtime

Qualifications

• Requires associate’s degree in nursing and an active RN license.
• Minimum 4 years care/case management and 2 years clinical/utilization review experience.
• Multi-state licensure required if providing services in multiple states.

Responsibilities

• Review the most complex or challenging cases requiring nursing judgment and holistic assessment to determine medical necessity.
• Consult with Medical Director on cases that are unclear or do not satisfy relevant criteria.
• Collaborate with case management nurses on discharge planning and ensuring appropriate equipment, environment, and education for safe discharge.

Skills

RN license

Care/case management

Utilization review

Multistate licensure

Microsoft Office

Inpatient hospital experience

Education

Associate degree in nursing

Tools

Microsoft Office

Job description

Elevance Health is seeking a Medical Management Nurse (CA Licensed) to assess complex cases, determine medical necessity, and consult with the Medical Director on nuanced cases. The role supports providers, educates members on plan benefits, and helps shape policies through collaboration with case management teams.

Locations include Woodland Hills, Walnut Creek, Costa Mesa, and Las Vegas; virtual/full-time options are available with required in-person training sessions and California overtime