Virtual Medical Management Nurse, RN Case Review

Elevance Health, Inc.; Oregon; Hybrid; USD 90.000 - 120.000; Vollzeit

Benefits dieser Stelle

Merit increases

Paid holidays

Paid Time Off

Medical

Dental

Vision

401(k) +match

Zusammenfassung

Elevance Health, Inc. is seeking a Medical Management Nurse - AmeriBen to review complex cases, applying nursing judgment to determine medical necessity and coordinating with providers for optimal member outcomes.

The role supports a remote-work model with occasional in-person training, a structured schedule, and opportunities to participate in policy development and quality initiatives. Strong RN credentials and multi-state licensure are required.

Qualifikationen

• Requires a minimum of an associate's degree in nursing.
• Minimum 4 years in care management or case management with at least 2 years in clinical, utilization review, or managed care, or equivalent.
• Active, valid RN license and multi-state licensure if applying across multiple states.

Aufgaben

• Review the most complex cases requiring nursing judgment to determine medical necessity.
• Collaborate with healthcare providers to assess a member's clinical picture and determine treatment needs.
• Provide nursing consultation to Medical Director on unclear or complex cases and to lower-level nurses as a resource.
• Support discharge planning with case management nurses and ensure appropriate equipment and education.

Kenntnisse

Nursing judgment

Care coordination

Clinical assessment

Team collaboration

Ausbildung

Associate degree in nursing

Jobbeschreibung

Elevance Health, Inc. is seeking a Medical Management Nurse - AmeriBen to review complex cases, applying nursing judgment to determine medical necessity and coordinating with providers for optimal member outcomes.

The role supports a remote-work model with occasional in-person training, a structured schedule, and opportunities to participate in policy development and quality initiatives. Strong RN credentials and multi-state licensure are required.