Remote Medical Management Nurse (RN) – Case Management

Elevance Health (Anthem); Indianapolis (IN); Remote; USD 85,000 - 110,000; Full time

Job summary

Elevance Health (Anthem) is seeking a Med Mgmt Nurse to support members remotely with periodic in-person training sessions. The role emphasizes nursing judgment to assess medical necessity, collaborate with providers, and optimize member outcomes.

The position requires an active RN license, 4+ years in care/case management, and at least 2 years in clinical, utilization review, or managed care. Crossing state licensure may apply and occasional on-site obligations may occur.

Qualifications

• Requires RN license
• 4+ years care management or case management experience
• 2+ years clinical, utilization review or managed care experience

Responsibilities

• Utilizes nursing judgment to analyze members' clinical information and apply guidelines to evaluate medical necessity.
• Promotes quality member outcomes by collaborating with healthcare providers and optimizing benefits.
• Assessments of abnormalities and determine if services align with diagnosis and care needs.
• Provide consultation to Medical Director on complex cases as needed.
• Collaborates with case management nurses on discharge planning and ensuring appropriate equipment and education.
• May participate in cross-functional teams and process improvement initiatives.
• Educates members about plan benefits and physicians; supports training materials.
• May assist with training lower-level clinician staff.

Skills

Nursing judgment

Clinical reasoning

Care management experience

Education

Associate's degree in nursing

Job description

Elevance Health (Anthem) is seeking a Med Mgmt Nurse to support members remotely with periodic in-person training sessions. The role emphasizes nursing judgment to assess medical necessity, collaborate with providers, and optimize member outcomes.

The position requires an active RN license, 4+ years in care/case management, and at least 2 years in clinical, utilization review, or managed care. Crossing state licensure may apply and occasional on-site obligations may occur.