Remote Medical Management RN - Complex Case Expert

Elevance Health, Inc.; United States; A distancia; USD 80.000 - 110.000; Jornada completa

Descripción de la vacante

Elevance Health is seeking a Medical Management Nurse (RN) for a virtual role with optional in-person trainings. The position requires an RN license, a minimum associate degree in nursing, and at least 4 years in care/case management plus 2 years in clinical/utilization review, with multi-state licensure as needed.

You’ll review complex cases, consult with Medical Director, and collaborate with clinicians to ensure medically necessary care.

Formación

• Requires associate’s degree in nursing.
• Minimum 4 years care management or case management experience and minimum 2 years clinical, utilization review, or managed care experience.
• Current active, valid and unrestricted RN license required.
• Multi-state licensure is required if providing services in multiple states.

Responsabilidades

• Analyze members’ clinical information and apply guidelines to evaluate medical necessity.
• Collaborate with providers to promote quality outcomes and appropriate resource use.
• Assess abnormalities and complex clinical concepts from member data.
• Determine when a member may not receive appropriate care and escalate as needed.
• Provide consultation to Medical Director on complex cases.
• Recommend alternate care types or settings based on nursing judgment.
• Collaborate with case management on discharge planning and education.
• Educate members about plan benefits and participate in training initiatives.

Conocimientos

Nursing judgment

Critical thinking

Holistic patient assessment

Communication with providers

Educación

Associate’s degree in nursing

RN license

Multi-state licensure

Descripción del empleo

Elevance Health is seeking a Medical Management Nurse (RN) for a virtual role with optional in-person trainings. The position requires an RN license, a minimum associate degree in nursing, and at least 4 years in care/case management plus 2 years in clinical/utilization review, with multi-state licensure as needed.

You’ll review complex cases, consult with Medical Director, and collaborate with clinicians to ensure medically necessary care.