Senior RN, Complex Care Management (Hybrid)

Elevance Health; United States; Hybrid; USD 45,000 - 85,000; Full time

Benefits offered by this job

Major medical

HSA

Dental

Vision

401k

Job summary

Elevance Health is a health company focused on improving lives and communities. We are seeking experienced nurse case managers to review complex cases, determine medical necessity, and consult with Medical Directors on difficult cases.

You will collaborate with providers to optimize member benefits and resource use. Role requires an active RN license, 4+ years in care/case management, and multi-state licensure for cross-state work.

Qualifications

• Requires an associate degree in nursing.
• Requires 4 years in care/case management and 2 years in clinical/utilization review or managed care.
• Current active, valid RN license and unrestricted status in applicable state(s).
• Multi-state licensure is required for multi-state service.

Responsibilities

• Review complex cases using nursing judgment to determine medical necessity.
• Collaborate with healthcare providers to assess clinical presentation and apply guidelines.
• Promote quality member outcomes and optimal use of resources.
• Consult Medical Director on particularly complex cases as needed.
• Provide nursing consultation and education to other staff as appropriate.

Skills

Nursing judgment

Care management

Utilization review

Case management

Clinical assessment

Education

Associate degree in nursing

Job description

Elevance Health is a health company focused on improving lives and communities. We are seeking experienced nurse case managers to review complex cases, determine medical necessity, and consult with Medical Directors on difficult cases.

You will collaborate with providers to optimize member benefits and resource use. Role requires an active RN license, 4+ years in care/case management, and multi-state licensure for cross-state work.