Remote Medical Management Nurse – Care Coordination

The Elevance Health Companies, Inc.; Urbandale (IA); Teletrabalho; USD 90 000 - 120 000; Tempo integral

Resumo da oferta

Elevance Health is seeking a Medical Management Nurse for AmeriBen to join our virtual team. This full‑time role allows remote work with required in‑person training, and a Monday–Friday, 8am–5pm MST schedule.

Responsibilities include using nursing judgment to analyze members’ clinical data, coordinate with providers, promote quality outcomes, and assess medical necessity per guidelines. Qualifications include an associate degree in nursing, an active RN license, and at least 4 years of care/case

Qualificações

• Requires an associate’s degree in nursing.
• Minimum 4 years care/case management experience and 2 years clinical/utilization review or managed care experience.
• Current active, valid RN license and multi-state licensure if applicable.

Responsabilidades

• Uses nursing judgment to analyze members’ clinical information and apply guidelines to evaluate medical necessity.
• Collaborates with healthcare providers to promote quality member outcomes and efficient resource use.
• Determines and assesses abnormalities by understanding clinical concepts and member information.
• Provides consultation to Medical Director on particularly complex cases as needed.
• May educate members about plan benefits and assist with case management.

Conhecimentos

Nursing judgment

Care management

RN license

Clinical reasoning

Formação académica

Associate degree in Nursing

Descrição da oferta de emprego

Elevance Health is seeking a Medical Management Nurse for AmeriBen to join our virtual team. This full‑time role allows remote work with required in‑person training, and a Monday–Friday, 8am–5pm MST schedule.

Responsibilities include using nursing judgment to analyze members’ clinical data, coordinate with providers, promote quality outcomes, and assess medical necessity per guidelines. Qualifications include an associate degree in nursing, an active RN license, and at least 4 years of care/case