Remote Medical Management Nurse (RN) – Flexible, Impactful

The Elevance Health Companies, Inc.; Indianapolis (IN); Remote; USD 70,000 - 90,000; Full time

Job summary

The Elevance Health Companies, Inc. is seeking a Medical Mgmt Nurse (RN) for a virtual role with in-person training sessions and occasional weekend obligations. You will assess complex clinical cases, determine medical necessity, and collaborate with physicians and care teams to optimize member outcomes.

The role emphasizes nursing judgment, policy adherence, and proactive member education while supporting hybrid/virtual work with required onsite onboarding and periodic reviews.

Qualifications

• Requires an Associate’s Degree in Nursing and an active RN license.
• Minimum 4 years of care management or case management experience.
• Minimum 2 years of clinical, utilization review, or managed care experience or equivalent.
• Active RN license to practice within the United States is required.

Responsibilities

• Review the most complex cases to determine medical necessity.
• Consult Medical Director on unclear or non-criteria cases.
• Collaborate with clinicians and discharge planning to ensure appropriate care.
• Educate members about plan benefits and services and promote quality outcomes.

Skills

Nursing judgement

Case management

Clinical assessment

Provider collaboration

Education

Associate’s Degree in Nursing

RN license

Job description

The Elevance Health Companies, Inc. is seeking a Medical Mgmt Nurse (RN) for a virtual role with in-person training sessions and occasional weekend obligations. You will assess complex clinical cases, determine medical necessity, and collaborate with physicians and care teams to optimize member outcomes.

The role emphasizes nursing judgment, policy adherence, and proactive member education while supporting hybrid/virtual work with required onsite onboarding and periodic reviews.