Virtual Medical Management RN - Case Review

Elevance Health; Indianapolis (IN); Remote; USD 90,000 - 120,000; Full time

Job summary

Elevance Health is seeking a Medical Management Nurse (RN) to review the most complex cases, apply nursing judgment, and determine medical necessity. You will work with providers to assess clinical presentations and advise Medical Director on unclear cases, contributing to policy improvements.

The role supports face-to-face onboarding, involves virtual work with periodic in-person training, and requires strong clinical judgment, case management experience, and an active RN license.

Qualifications

• Requires an Associate’s Degree in Nursing.
• Requires 4+ years of care management or case management experience and 2+ years of clinical, utilization review, or managed care experience; or equivalent experience.
• Current active, valid and unrestricted RN license to practice in applicable state(s) in the United States.

Responsibilities

• Analyze complex clinical information to determine medical necessity and consult with Medical Director as needed.
• Collaborate with healthcare providers to promote quality member outcomes and appropriate use of resources.
• Assist with discharge planning and ensure patient has necessary equipment and education.

Skills

Care management

RN judgment

Utilization review

Communication

Education

Associate’s Degree in Nursing

RN license

Job description

Elevance Health is seeking a Medical Management Nurse (RN) to review the most complex cases, apply nursing judgment, and determine medical necessity. You will work with providers to assess clinical presentations and advise Medical Director on unclear cases, contributing to policy improvements.

The role supports face-to-face onboarding, involves virtual work with periodic in-person training, and requires strong clinical judgment, case management experience, and an active RN license.