Remote RN: Medical Management & Case Review

Elevance Health; Florida; Remote; USD 75,000 - 100,000; Full time

Job summary

AmeriBen, a proud member of Elevance Health, is seeking a Medical Management Nurse to review complex cases, determine medical necessity, and provide nursing judgment in collaboration with healthcare providers.

This remote, full-time role emphasizes flexibility, with in-person training and occasional on-site requirements; candidates should have an associate degree in nursing, RN license, and 4+ years in care management, including multi-state licensure.

Qualifications

• Requires RN license active and eligibility to practice in applicable states.
• Minimum of 4 years in care/case management plus 2 years clinical/utilization review.
• Multi-state licensure required if providing services in multiple states.

Responsibilities

• Analyze members’ clinical information using nursing judgment and apply guidelines to assess medical necessity.
• Collaborate with healthcare providers to promote quality outcomes and appropriate resource use.
• Assist with discharge planning to ensure proper equipment, environment, and education.
• Provide consultation to Medical Director on complex cases and other stakeholders on process improvements.
• Support training, policy development, and intradepartmental projects.

Skills

Nursing judgment

Clinical assessment

Care management

Interprofessional collaboration

Education

Associate degree in nursing

Job description

AmeriBen, a proud member of Elevance Health, is seeking a Medical Management Nurse to review complex cases, determine medical necessity, and provide nursing judgment in collaboration with healthcare providers.

This remote, full-time role emphasizes flexibility, with in-person training and occasional on-site requirements; candidates should have an associate degree in nursing, RN license, and 4+ years in care management, including multi-state licensure.