Remote RN - Medical Management & Case Review

Elevance Health; Mason (OH); Hybrid; USD 80,000 - 110,000; Full time

Job summary

AmeriBen, a member of Elevance Health, is seeking a Medical Management Nurse to review complex cases for medical necessity with nursing judgment. You will collaborate with healthcare providers and the Medical Director to ensure appropriate care and outcomes.

The role supports hybrid/virtual work with required in-person training and occasional weekends, offering flexibility and opportunities to influence clinical policies.

Qualifications

• Requires Associate 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 RN license and/or applicable licensure; multi-state licensure if practicing across states.

Responsibilities

• Review complex cases to determine medical necessity.
• Collaborate with healthcare providers to assess clinical pictures.
• Consult Medical Director on unclear or complex cases.
• Educate members about plan benefits and care options.
• Partner with case management on discharge planning.
• Support policy improvement and training initiatives.

Skills

Nursing judgment

Case management

Clinical assessment

Communication

Education

Associate degree in nursing

Tools

EHR systems

Job description

AmeriBen, a member of Elevance Health, is seeking a Medical Management Nurse to review complex cases for medical necessity with nursing judgment. You will collaborate with healthcare providers and the Medical Director to ensure appropriate care and outcomes.

The role supports hybrid/virtual work with required in-person training and occasional weekends, offering flexibility and opportunities to influence clinical policies.