Remote Medical Management Nurse – Complex Case Review

The Elevance Health Companies, Inc.; Atlanta (GA); Remote; USD 70,000 - 100,000; Full time

Job summary

Elevance Health is seeking a Medical Management Nurse to review complex cases, apply clinical guidelines, and determine medical necessity. You will collaborate with healthcare providers, consult the Medical Director on challenging cases, and serve as a resource for clinicians.

The role emphasizes driving quality outcomes, supporting case management, and contributing to program improvements while working in a remote, second-shift environment consistent with Elevance Health’s hybrid policies.

Qualifications

• Requires an associate's degree in nursing.
• Minimum 4 years of care/case management experience; 2 years in clinical, utilization review, or managed care; or equivalent background.
• Active, valid RN license and multi-state licensure as needed.

Responsibilities

• Review complex cases to determine medical necessity.
• Consult with Medical Director on unclear cases and provide nursing consultation to clinicians.
• Act as a resource for lower-level nurses and participate in cross-functional projects and process improvements.
• Assist with policy development and quality audits and education.

Skills

Nursing judgment

Clinical assessment

Healthcare collaboration

Quality improvement

Medical terminology

Education

Associate degree in nursing

RN license

Job description

Elevance Health is seeking a Medical Management Nurse to review complex cases, apply clinical guidelines, and determine medical necessity. You will collaborate with healthcare providers, consult the Medical Director on challenging cases, and serve as a resource for clinicians.

The role emphasizes driving quality outcomes, supporting case management, and contributing to program improvements while working in a remote, second-shift environment consistent with Elevance Health’s hybrid policies.