Remote Medical Management Nurse (RN)

Elevance Health; Atlanta (GA); Hybrid; USD 90,000 - 120,000; Full time

Job summary

Elevance Health is seeking a Medical Management Nurse (RN) to conduct in-depth reviews of complex cases to determine medical necessity and approvals for services. The role emphasizes nursing judgment, collaboration with clinicians, and consultation with the Medical Director as needed.

This hybrid, virtual-capable position supports training sessions in person and requires multi-state licensure if applicable.

Qualifications

• Requires an active RN license in applicable state(s).
• Minimum 4 years in care/case management and 2 years in clinical/utilization review or managed care.
• Multi-state licensure is required if working in multiple states.

Responsibilities

• Review the most complex cases to determine medical necessity and approve services.
• Consult Medical Director on unclear cases and provide nursing guidance to clinicians.
• Collaborate with case management on discharge planning and ensure safe patient outcomes.
• Educate members about plan benefits and assist with case management processes.
• Assist leadership with process improvement and training of staff.

Education

Associate’s degree in nursing

Job description

Elevance Health is seeking a Medical Management Nurse (RN) to conduct in-depth reviews of complex cases to determine medical necessity and approvals for services. The role emphasizes nursing judgment, collaboration with clinicians, and consultation with the Medical Director as needed.

This hybrid, virtual-capable position supports training sessions in person and requires multi-state licensure if applicable.