Remote RN Medical Management Specialist

Elevance Health; St. Louis (MO); Ibrido; USD 85.000 - 120.000; Tempo pieno

Vantaggi offerti da questo lavoro

Hybrid work model

Descrizione del lavoro

Elevance Health's AmeriBen unit seeks a Medical Management Nurse to review complex cases, determine medical necessity, and collaborate with providers and the Medical Director. This hybrid role supports virtual work with required in-person training sessions and onboarding.

A nursing degree, active RN license, and multi-state licensure are required, with prior care/case management experience. You will engage in discharge planning, education, and policy improvement across teams, contributing to

Competenze

• Requires an associate's degree in nursing.
• Requires 4+ years care/case management experience and 2+ years clinical/utilization review or managed care experience.
• Current active, valid and unrestricted RN license in applicable state(s).
• Multi-state licensure required if serving multiple states.

Mansioni

• Utilizes nursing judgment to analyze members' clinical information and apply guidelines to evaluate medical necessity.
• Collaborates with healthcare providers to promote quality outcomes and resource use.
• Assesses abnormalities and complex clinical concepts within members' care.
• Provides consultation to Medical Director on complex or unclear cases.
• Collaborates on discharge planning and member education.
• May train lower-level clinician staff.
• Participates in process improvement initiatives.

Conoscenze

Nursing judgment

Case management

Clinical assessment

Multistate licensure

Formazione

Associate's degree in nursing

Descrizione del lavoro

Elevance Health's AmeriBen unit seeks a Medical Management Nurse to review complex cases, determine medical necessity, and collaborate with providers and the Medical Director. This hybrid role supports virtual work with required in-person training sessions and onboarding.

A nursing degree, active RN license, and multi-state licensure are required, with prior care/case management experience. You will engage in discharge planning, education, and policy improvement across teams, contributing to