Virtual RN: Medical Management Specialist

Elevance Health; Urbandale (IA); Hybride; USD 70 000 - 95 000; Plein temps

Avantages offerts par ce poste

Medical benefits

Dental benefits

Vision benefits

Short and long term disability

401(k) with match

Stock purchase plan

Life insurance

Wellness programs

Résumé du poste

Elevance Health is seeking a Medical Management Nurse to review complex cases, determine medical necessity, and advise on care plans. This role supports clinicians, collaborates with case management, and helps optimize member outcomes across the health plan.

The position offers virtual work with occasional in-person trainings and requires an active RN license and 4+ years in care management. Elevance Health emphasizes equity, retention, and comprehensive benefits.

Qualifications

• Requires associate degree in nursing.
• Minimum 4 years in care or case management with 2 years clinical/utilization review or managed care experience.
• Active RN license with multi-state licensure if practicing in more than one state.

Responsabilités

• Review complex cases to determine medical necessity using nursing judgment.
• Collaborate with providers to assess patient clinical pictures and outcomes.
• Consult Medical Director on unclear or atypical cases.
• Assist with special projects and contribute to policy improvements.
• Educate members about plan benefits and assist with discharge planning.

Connaissances

Nursing

Care management

Clinical judgment

Utilization review

Multistate licensure

Formation

Associate degree in nursing

Description du poste

Elevance Health is seeking a Medical Management Nurse to review complex cases, determine medical necessity, and advise on care plans. This role supports clinicians, collaborates with case management, and helps optimize member outcomes across the health plan.

The position offers virtual work with occasional in-person trainings and requires an active RN license and 4+ years in care management. Elevance Health emphasizes equity, retention, and comprehensive benefits.