Remote Medical Management Nurse - Complex Case Review

Elevance Health; Louisville (KY); Remote; USD 85,000 - 105,000; Full time

Job summary

Elevance Health is seeking a Medical Management Nurse (AmeriBen) to work remotely with periodic in-person trainings. The role analyzes complex clinical data to determine medical necessity, collaborates with providers, and supports Medical Director on challenging cases.

It also involves education, discharge planning, and participation in process improvements. The position requires an RN license, an associate degree, and multi-state licensure as needed, with typical hybrid/virtual work

Qualifications

• Requires an associate's degree in nursing and active RN license.
• Minimum 4 years of care/case management experience with 2 years in clinical/utilization review.
• Multi-state licensure required if serving multiple states.

Responsibilities

• Review complex cases to determine medical necessity and obtain approval.
• Collaborate with healthcare providers to assess members' clinical pictures.
• Provide nursing consultation to Medical Director on unclear cases.
• Serve as a resource to clinicians and participate in quality/process improvements.
• Educate members about plan benefits and assist with case management.
• Contribute to training materials and discharge planning when needed.

Skills

Nursing judgment

Critical thinking

Collaboration

Communication

Education

Associate's degree in nursing

Job description

Elevance Health is seeking a Medical Management Nurse (AmeriBen) to work remotely with periodic in-person trainings. The role analyzes complex clinical data to determine medical necessity, collaborates with providers, and supports Medical Director on challenging cases.

It also involves education, discharge planning, and participation in process improvements. The position requires an RN license, an associate degree, and multi-state licensure as needed, with typical hybrid/virtual work