Virtual Medical Management Nurse – Complex Case Expert

Elevance Health, Inc.; Indianapolis (IN); Híbrido; USD 85.000 - 110.000; Jornada completa

Ventajas ofrecidas por este puesto de trabajo

Medical, dental, vision benefits

401(k) + match

Wellness programs

Paid time off

Descripción de la vacante

Elevance Health is seeking a Med Mgmt. Nurse who reviews the most complex cases requiring nursing judgment and holistic assessment to determine medical necessity.

The role works with providers to understand a patient’s clinical picture, offers consultation to the Medical Director on unclear cases, and contributes to policy development and training materials. Hybrid work with in-person sessions as needed.

Formación

• Associate degree in nursing required.
• 4+ years care/case management experience and 2+ years clinical/utilization review or managed care experience.
• Current active RN license; multi-state licensure if working in multiple states.

Responsabilidades

• Review complex cases using nursing judgment to determine medical necessity.
• Collaborate with healthcare providers to assess patient clinical pictures and treatment plans.
• Provide consultation to Medical Director on particularly complex or unclear cases.
• Assist in policy development, training materials, and process improvement initiatives.
• Educate members about plan benefits and collaborate with clinicians to optimize care.

Conocimientos

Nursing judgment

Critical thinking

Holistic assessment

Collaboration with clinicians

Educación

Associate degree in nursing

RN license (active/unrestricted)

Descripción del empleo

Elevance Health is seeking a Med Mgmt. Nurse who reviews the most complex cases requiring nursing judgment and holistic assessment to determine medical necessity.

The role works with providers to understand a patient’s clinical picture, offers consultation to the Medical Director on unclear cases, and contributes to policy development and training materials. Hybrid work with in-person sessions as needed.