About the role
Elevance Health is hiring a virtual Medical Management Nurse to review the most complex or challenging cases and decide whether requested services are medically necessary. You'll work with providers, consult Medical Directors on unclear cases, and serve as a resource for other nurses. The role is virtual full-time apart from required in-person training, and candidates must live within commuting distance of a listed Elevance office (Grand Prairie, TX is one of them).
Responsibilities
- Analyze members' clinical information and apply clinical guidelines and policies to judge medical necessity
- Work with healthcare providers to understand each member's clinical picture and promote quality outcomes
- Recognize when a member may not be getting the right type, level, or quality of care and suggest alternatives
- Consult Medical Directors on unusual or complex cases
- Partner with case management nurses on discharge planning
- Serve as a resource and trainer for lower-level clinicians and join process-improvement projects and quality audits
Requirements
- Associate degree in nursing at minimum
- At least 4 years of care management or case management experience
- At least 2 years of clinical, utilization review, or managed care experience
- Current, active, unrestricted RN license; multistate licensure required if serving members in multiple states
- Must live within a reasonable commuting distance of a posted Elevance office (virtual role with required in-person training)
What we offer
- Comprehensive benefits package with incentive and recognition programs
- Equity stock purchase plan
- 401(k) contribution
- Virtual work arrangement after in-person training