Remote Medical Management Nurse (RN) - Complex Case Expert

The Elevance Health Companies, Inc.; Indianapolis (IN); A distancia; USD 85.000 - 110.000; Jornada completa

Descripción de la vacante

Elevance Health is seeking a Medical Management Nurse (RN) to review complex cases and determine medical necessity with nursing judgment. The role involves collaboration with healthcare providers, consultation with the Medical Director, and supporting clinicians in assessing and improving member care.

Position supports virtual work with required in-person training sessions; travel or alternate locations may be considered within commuting distance and subject to policy.

Formación

• Requires a minimum of associate’s degree in nursing.
• Requires a minimum of 4 years care management or case management experience and a minimum of 2 years clinical, utilization review, or managed care experience.
• Current active, valid and unrestricted RN license and/or certification to practice as a health professional within the scope of licensure in applicable state(s) or territory of the United States.
• Multi-state licensure is required if providing services in multiple states.

Responsabilidades

• Review the most complex or challenging cases requiring nursing judgment and holistic assessment to determine medical necessity.
• Collaborate with healthcare providers to understand and assess a member’s clinical picture.
• Provide consultation to Medical Director on unclear cases and those not meeting clinical criteria.
• Act as a resource for Clinicians and participate in special projects and policy improvements.
• Promote quality member outcomes and appropriate use of resources.

Educación

Associate degree in nursing

Descripción del empleo

Elevance Health is seeking a Medical Management Nurse (RN) to review complex cases and determine medical necessity with nursing judgment. The role involves collaboration with healthcare providers, consultation with the Medical Director, and supporting clinicians in assessing and improving member care.

Position supports virtual work with required in-person training sessions; travel or alternate locations may be considered within commuting distance and subject to policy.