Remote Medical Management Nurse | Care Coordination

Elevance Health (Anthem); Metairie (LA); Remote; USD 85,000 - 110,000; Full time

Job summary

Elevance Health in Metairie is seeking a Medical Management Nurse. The role uses nursing judgment to assess medical necessity and collaborates with providers to promote appropriate, high-quality care. Remote eligibility is offered with required in-person training sessions.

The position emphasizes patient outcomes, case management collaboration, and support for Medical Director on complex cases. Multistate licensure may be required.

Qualifications

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

Responsibilities

• Utilize nursing judgment to analyze members' clinical information and assess medical necessity.
• Collaborate with healthcare providers to promote quality outcomes and optimize benefits.
• Provide consultation to Medical Director on complex cases as needed.
• Assist with discharge planning and patient education to ensure safe transitions.
• Participate in process improvement initiatives and training activities.

Skills

Care management experience

RN licensure

Healthcare policy understanding

Education

Associate's degree in nursing

RN license (active)

Job description

Elevance Health in Metairie is seeking a Medical Management Nurse. The role uses nursing judgment to assess medical necessity and collaborates with providers to promote appropriate, high-quality care. Remote eligibility is offered with required in-person training sessions.

The position emphasizes patient outcomes, case management collaboration, and support for Medical Director on complex cases. Multistate licensure may be required.