Remote Medical Management Nurse RN Case Expert

Elevance Health; Miami (FL); Hybrid; USD 65,000 - 90,000; Full time

Benefits offered by this job

Hybrid work model

Job summary

Elevance Health's AmeriBen unit seeks a Medical Management Nurse to review complex cases and determine medical necessity, coordinating with healthcare providers to ensure appropriate care and outcomes. The role supports in-person training within a hybrid/remote model and requires an active RN license with multi-state eligibility.

It emphasizes nursing judgment, collaboration, and ongoing policy improvement across the organization.

Qualifications

• Requires an associate’s degree in nursing.
• Minimum 4 years care/case management experience and minimum 2 years clinical/utilization review/managed care experience.
• Current active, valid and unrestricted RN license; multi-state licensure if working across states.

Responsibilities

• Review the most complex cases to determine medical necessity and advise on approvals.
• Collaborate with healthcare providers to assess patient clinical pictures.
• Provide nursing consultation to Medical Director on complex cases and participate in policy improvement.

Education

Associate degree in nursing

RN license

Job description

Elevance Health's AmeriBen unit seeks a Medical Management Nurse to review complex cases and determine medical necessity, coordinating with healthcare providers to ensure appropriate care and outcomes. The role supports in-person training within a hybrid/remote model and requires an active RN license with multi-state eligibility.

It emphasizes nursing judgment, collaboration, and ongoing policy improvement across the organization.