Remote RN: Medical Management & Case Review

Elevance Health; Virginia (MN); Hybrid; USD 85,000 - 110,000; Full time

Benefits offered by this job

Job summary

Elevance Health is seeking a Medical Management Nurse - AmeriBen to review complex cases, determine medical necessity, and collaborate with healthcare providers. The role emphasizes nursing judgment, holistic assessment, and consultation with the Medical Director on unclear cases.

Flexible work arrangements include virtual and limited in-person training. As part of the AmeriBen team within Elevance Health, you will support plan benefits, ensure quality care, and participate in cross-functional

Qualifications

• Requires an associate’s degree in nursing.
• Requires a minimum of 4 years care management or case management experience and a minimum of 2 years clinical, utilization review, or managed care experience.
• Multi-state licensure is required if providing services in multiple states.

Responsibilities

• Review of the most complex or challenging cases to determine medical necessity.
• Collaborate with healthcare providers to assess a member’s clinical picture and determine appropriate care.
• Provide consultation to Medical Director on complex cases.
• Serve as a resource for clinicians and lower-level nurses.
• Assist with policy development and process improvements.

Skills

RN licensure

Nursing assessment

Care management

Critical thinking

Education

Associate degree in Nursing

Job description

Elevance Health is seeking a Medical Management Nurse - AmeriBen to review complex cases, determine medical necessity, and collaborate with healthcare providers. The role emphasizes nursing judgment, holistic assessment, and consultation with the Medical Director on unclear cases.

Flexible work arrangements include virtual and limited in-person training. As part of the AmeriBen team within Elevance Health, you will support plan benefits, ensure quality care, and participate in cross-functional