Remote RN: Medical Management Specialist

Elevance Health; Indianapolis (IN); Híbrido; USD 90.000 - 120.000; Jornada completa

Descripción de la vacante

Elevance Health is seeking a Medical Management Nurse (RN) to review complex cases for medical necessity and collaborate with healthcare providers. The role emphasizes nursing judgment, critical thinking, and holistic assessment to support appropriate care decisions and case management activities.

The position offers hybrid/virtual options with some in-person training, and requires an active RN license with multi-state eligibility.

Formación

• Minimum associate’s degree in nursing.
• 4+ years care management or case management experience and 2+ years clinical, utilization review, or managed care experience.

Responsabilidades

• Analyze complex clinical information to determine medical necessity.
• Collaborate with healthcare providers to evaluate patient plans and outcomes.
• Provide nursing consultation to Medical Director on complex cases.
• Support discharge planning and coordination of care.
• Educate members about plan benefits and services.
• Contribute to process improvement and training initiatives.

Conocimientos

Nursing judgment

Clinical assessment

Healthcare collaboration

Policy awareness

Educación

Associate degree in nursing

Descripción del empleo

Elevance Health is seeking a Medical Management Nurse (RN) to review complex cases for medical necessity and collaborate with healthcare providers. The role emphasizes nursing judgment, critical thinking, and holistic assessment to support appropriate care decisions and case management activities.

The position offers hybrid/virtual options with some in-person training, and requires an active RN license with multi-state eligibility.