Remote RN – Medical Management & Complex Case Review

Elevance Health; Costa Mesa (CA); On-site; USD 84,000 - 144,000; Full time

Job summary

Elevance Health is seeking a Medical Management Nurse (CA) to review complex cases, exercise nursing judgment, and determine medical necessity for services. You will work with clinicians and the Medical Director to ensure appropriate care and contribute to policy improvements.

This role supports hybrid/remote work with in-person training, requires active RN licensure (multi-state where applicable), and care/case management experience.

Qualifications

• RN license Active and unrestricted in applicable state(s).
• Minimum 4 years in care/case management.
• 2 years clinical/utilization review or managed care.
• MS Office proficiency preferred.

Responsibilities

• Analyze complex clinical information to determine medical necessity.
• Collaborate with healthcare providers to optimize outcomes.
• Provide nursing consultation to Medical Director on complex cases.
• Assist with policy development and special projects.
• Coordinate discharge planning and training for staff.

Skills

Nursing judgment

Care management

Case management

Multistate licensure

Microsoft Office

Education

Associate’s degree in nursing

Tools

Microsoft Office

Job description

Elevance Health is seeking a Medical Management Nurse (CA) to review complex cases, exercise nursing judgment, and determine medical necessity for services. You will work with clinicians and the Medical Director to ensure appropriate care and contribute to policy improvements.

This role supports hybrid/remote work with in-person training, requires active RN licensure (multi-state where applicable), and care/case management experience.