Remote Medical Management Nurse – Case Review

Elevance Health; Atlanta (GA); À distance; USD 90 000 - 120 000; Plein temps

Résumé du poste

Elevance Health is seeking a Medical Management Nurse to review complex cases and determine medical necessity using nursing judgment while collaborating with providers and applying clinical guidelines.

The role is remote with occasional in-person training, requiring an active RN license, multi-state licensure where needed, and shift overlap Monday–Friday 11:30 a.m. to 8:00 p.m. ET to support member care.

Qualifications

• Requires an associate’s degree in nursing.
• Minimum 4 years’ care management or case management experience.
• Minimum 2 years clinical, utilization review, or managed care experience.
• Current active, valid and unrestricted RN license and/or certification to practice as a health professional within the scope of licensure in applicable state(s) or territory of the United States.

Responsabilités

• Analyze members’ clinical information using nursing judgement to determine medical necessity.
• Collaborate with healthcare providers to assess clinical presentation and apply guidelines.
• Consult with Medical Director on complex cases.
• Assist with discharge planning and education for safe transitions.
• Provide nursing consultation to Medical Directors and clinicians.
• Support process improvements and training initiatives.

Connaissances

Nursing judgement

Critical thinking

Holistic assessment

Formation

Associate's degree in nursing

Description du poste

Elevance Health is seeking a Medical Management Nurse to review complex cases and determine medical necessity using nursing judgment while collaborating with providers and applying clinical guidelines.

The role is remote with occasional in-person training, requiring an active RN license, multi-state licensure where needed, and shift overlap Monday–Friday 11:30 a.m. to 8:00 p.m. ET to support member care.