Remote Medical Management Nurse - Complex Case Reviewer

Elevance Health; Indianapolis (IN); Híbrido; USD 85.000 - 110.000; Jornada completa

Descripción de la vacante

Elevance Health is seeking a Med Mgmt Nurse to review complex cases, determine medical necessity, and provide nursing judgment and consultation to the Medical Director. You will work with healthcare providers to ensure appropriate care and contribute to policy development.

The role emphasizes collaboration across case management teams and participation in process improvement projects while supporting training and orientation materials.

Formación

• Requires an associate’s degree in nursing.
• Requires a minimum of 4 years care management or case management experience and a minimum of 2 years clinical, utilization review, or managed care experience; or any combination of education and experience.
• Current active, valid and unrestricted RN license and/or certification to practice as a health professional within the scope of licensure in home state or territory of the United States required.
• Multi-state licensure is required if this individual is providing services in multiple states.

Responsabilidades

• Uses nursing judgment to assess member information and determine medical necessity.
• Collaborates with healthcare providers to promote quality outcomes and appropriate use of resources.
• Provides consultation to Medical Director on complex cases.
• Acts as a resource to lower-level nurses and participates in process improvement.

Conocimientos

Nursing judgment

Critical thinking

Case management

Communication

Educación

Associate's degree in nursing

RN license

Multistate licensure

Descripción del empleo

Elevance Health is seeking a Med Mgmt Nurse to review complex cases, determine medical necessity, and provide nursing judgment and consultation to the Medical Director. You will work with healthcare providers to ensure appropriate care and contribute to policy development.

The role emphasizes collaboration across case management teams and participation in process improvement projects while supporting training and orientation materials.