Remote Medical Management Nurse – Case Review Expert

Elevance Health, Inc.; Virginia Beach (VA); Remote; USD 53,000 - 79,000; Full time

Benefits offered by this job

401(k) match

Medical, dental, vision benefits

Paid time off

Job summary

Elevance Health, Inc. is seeking a Medical Management Nurse to evaluate the most complex cases, using nursing judgment and holistic assessment to determine medical necessity.

The role collaborates with providers and Medical Directors to discuss care decisions and ensure appropriate member outcomes. The position requires an RN license, an associate degree, and several years in care/case management or utilization review, with a hybrid/remote work setup and opportunities for professional

Qualifications

• Requires an associate's degree in nursing.
• Minimum 4 years care/case management experience; 2 years clinical/utilization review or managed care experience.
• Active RN license or equivalent in applicable state(s).

Responsibilities

• Analyze complex clinical information and determine medical necessity using nursing judgment.
• Collaborate with healthcare providers to assess and plan member care.
• Provide consultation to Medical Director on complex cases and advise on appropriate care settings.

Skills

Nursing judgment

Critical thinking

Clinical assessment

Case management

Interprofessional collaboration

Education

Associate's degree in nursing

Job description

Elevance Health, Inc. is seeking a Medical Management Nurse to evaluate the most complex cases, using nursing judgment and holistic assessment to determine medical necessity.

The role collaborates with providers and Medical Directors to discuss care decisions and ensure appropriate member outcomes. The position requires an RN license, an associate degree, and several years in care/case management or utilization review, with a hybrid/remote work setup and opportunities for professional