Senior RN: Care Management & Utilization Review (Remote)

Elevance Health; Indianapolis (IN); Hybrid; USD 44,565 - 85,108; Full time

Benefits offered by this job

Major medical

HSA

Dental

Vision

Group life

Voluntary life

Short-term disability

Long-term disability

401(k)

Job summary

Elevance Health is seeking an experienced nurse for complex case management and medical necessity determinations. You will collaborate with clinicians, discharge planning teams, and the Medical Director to ensure quality care and appropriate utilization.

The role emphasizes nursing judgment, holistic assessment, and cross-functional collaboration, with remote work options and a hybrid attendance model as per Elevance Health policies.

Qualifications

• Associate's degree in nursing required.
• 4+ years in care management or case management and at least 2 years in clinical, utilization review, or managed care.
• Active, valid, unrestricted RN license and/or certification in the applicable U.S. state(s) or territory; multi-state licensure if servicing multiple states.

Responsibilities

• Review complex cases to determine medical necessity.
• Collaborate with providers to assess clinical pictures and advise Medical Director on unclear cases.
• Serve as a resource for clinicians and assist with discharge planning and equipment/education needs.

Skills

Nursing

Case management

Utilization review

Clinical assessment

Education

Associate's degree in nursing

Job description

Elevance Health is seeking an experienced nurse for complex case management and medical necessity determinations. You will collaborate with clinicians, discharge planning teams, and the Medical Director to ensure quality care and appropriate utilization.

The role emphasizes nursing judgment, holistic assessment, and cross-functional collaboration, with remote work options and a hybrid attendance model as per Elevance Health policies.