Remote Medical Management Nurse - Complex Case Specialist

Elevance Health; Leawood (KS); Hybrid; USD 88,000 - 110,000; Full time

Benefits offered by this job

Merit increases

Paid holidays

Paid Time Off

Incentive bonus programs

401(k) + match

Stock purchase plan

Job summary

Elevance Health seeks a Medical Management Nurse – AmeriBen, a trusted member of our family, to review complex cases, determine medical necessity, and collaborate with providers.

This hybrid/remote role offers in-person onboarding; requires RN license, associate degree, and care management experience. You will support Medical Director and mentor clinicians while contributing to policy improvements.

Join us to help deliver quality member care and optimize resources across our national network.

Qualifications

• Requires an associate’s degree in nursing.
• Minimum 4 years care management or case management experience and at least 2 years in clinical, utilization review, or managed care.
• Current active, valid RN license; multi-state licensure if practicing in multiple states.
• Preferred: prior healthcare third party vendor (TPA) experience.

Responsibilities

• Review complex cases requiring nursing judgment and holistic assessment to determine medical necessity.
• Collaborate with healthcare providers to understand patient clinical pictures.
• Consult with Medical Director on unclear cases and advise on appropriate care.
• Act as a resource for Clinicians and support policy development.
• Participate in cross-functional teams and process improvement initiatives.
• Educate members about plan benefits and assist with case management.

Skills

Nursing judgment

Care management

Clinical collaboration

Interdisciplinary teamwork

Education

Associate degree in nursing

Job description

Elevance Health seeks a Medical Management Nurse – AmeriBen, a trusted member of our family, to review complex cases, determine medical necessity, and collaborate with providers.

This hybrid/remote role offers in-person onboarding; requires RN license, associate degree, and care management experience. You will support Medical Director and mentor clinicians while contributing to policy improvements.

Join us to help deliver quality member care and optimize resources across our national network.