Remote Medical Management Nurse Specialist

Elevance Health; Waukesha (WI); À distance; USD 90 000 - 120 000; Plein temps

Résumé du poste

Elevance Health’s AmeriBen unit is hiring a Medical Management Nurse to review highly complex cases, applying nursing judgment and holistic assessment to determine medical necessity. You will work with clinicians and the Medical Director, supporting policy development and special projects.

The role emphasizes virtual work, with occasional in-person training and onboarding. The nurse analyzes clinical information, promotes quality outcomes, and collaborates across multidisciplinary teams.

Qualifications

• Requires an associate degree in nursing.
• Minimum 4 years of care/case management experience and at least 2 years in clinical, utilization review, or managed care.
• Current active, valid RN license or equivalent in applicable states; multi-state licensure required if practicing in multiple states.
• Licensing and credentials must be in good standing as required by state regulations.

Responsabilités

• Utilizes nursing judgment to assess members’ clinical information and determine medical necessity.
• Collaborates with healthcare providers to promote quality outcomes and appropriate resource use.
• Provides consultation to Medical Director on complex or unclear cases.
• May train or mentor lower-level clinical staff and participate in process improvement initiatives.

Connaissances

Nursing judgment

Clinical assessment

Case management

Healthcare collaboration

Formation

Associate degree in nursing

Description du poste

Elevance Health’s AmeriBen unit is hiring a Medical Management Nurse to review highly complex cases, applying nursing judgment and holistic assessment to determine medical necessity. You will work with clinicians and the Medical Director, supporting policy development and special projects.

The role emphasizes virtual work, with occasional in-person training and onboarding. The nurse analyzes clinical information, promotes quality outcomes, and collaborates across multidisciplinary teams.