Remote Medical Management Nurse - Complex Case Reviewer

Elevance Health, Inc.

Nashville (TN)

Remote

USD 90.000 - 130.000

Vollzeit

14 Tage+

Eine vollständige Bewerbung in einer Minute

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Benefits dieser Stelle

Hybrid/remote work options

Competitive benefits package

Professional development opportunities

Zusammenfassung

Elevance Health's AmeriBen division seeks a Medical Management Nurse for virtual, full-time work. You will review complex cases to determine medical necessity, consult with providers, and support medical directors on challenging cases.

In addition to clinical assessment, you will participate in policy development and care coordination initiatives. The position requires an RN license, 4+ years in care/case management, and 2+ years in clinical/utilization review, with multi-state licensure as

Qualifikationen

Requires an associate degree in nursing.
Minimum 4 years care management or case management experience and minimum 2 years clinical, utilization review, or managed care experience.
Current active, valid RN license and/or certification to practice within applicable state(s). Multi-state licensure if providing services in multiple states.

Aufgaben

Review complex cases to determine medical necessity and approve services.
Collaborate with healthcare providers to assess member clinical presentation.
Provide nursing consultation to Medical Director on complex cases and participate in process improvements.

Kenntnisse

RN license

Clinical judgment

Utilization review

Care management

Ausbildung

Associate degree in nursing

Tools

EMR systems

Jobbeschreibung

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