Elevance Health
Overview
Medical Management Nurse at Elevance Health. This is a virtual/full-time role with required in-person training sessions. The position supports flexible and autonomous work arrangements with onboarding and skill development conducted in person as needed. Location:
Virtual; candidates may be required to travel for in-person training as part of onboarding. Hybrid/virtual work policy applies; candidates outside reasonable commuting distance will not be considered unless an accommodation is granted by law. Hours:
Monday – Friday, 8:00 am to 6:00 pm (time zone dependent) with 1–2 Saturdays per year. Salary/Locations:
For candidates working in person or virtually in the locations below, the salary range for this position is $82,152 to $123,228. Locations: New York. Elevance Health is a Fortune 25 health company focused on improving lives and communities. Elevance Health is an Equal Employment Opportunity employer and all qualified applicants will receive consideration for employment without regard to age, citizenship status, color, creed, disability, ethnicity, genetic information, gender, marital status, national origin, race, religion, sex, sexual orientation, veteran status or any other status protected by law. Responsibilities
Review the most complex or challenging cases requiring nursing judgment, critical thinking, and holistic assessment to determine whether to approve services as medically necessary. Work with healthcare providers to understand and assess a member’s clinical picture; use nursing judgment to determine medical necessity and provide consultation to the Medical Director on unclear cases. Serve as a resource for clinicians; participate in special projects and help craft, implement, and improve organizational policies. Collaborate with case management nurses on discharge planning to ensure appropriate equipment, environment, and education for safe discharge. Provide nursing consultation to Medical Director and/or Providers on select, complex, or unclear cases; educate and support lower-level nurses. Assist with process improvement initiatives and training materials; participate in intradepartmental and cross-functional teams. Educate members about plan benefits and assist with case management as needed. Minimum Requirements
Associate’s degree in nursing; minimum of 4 years of care management or case management experience; minimum of 2 years of clinical, utilization review, or managed care experience, or equivalent combination of education and experience. Current active, valid, and unrestricted RN license and/or certification to practice within applicable state(s); multi-state licensure required if providing services in multiple states. Preferred Capabilities, Skills And Experiences
Medical Management experience preferred. Utilization Review experience preferred. Knowledge of medical management processes and ability to interpret/apply member contracts and managed care products is strongly preferred. Be advised that Elevance Health accepts resumes for compensation from agencies with a signed agreement. The company emphasizes equal pay and opportunities in accordance with applicable laws.
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Medical Management Nurse at Elevance Health. This is a virtual/full-time role with required in-person training sessions. The position supports flexible and autonomous work arrangements with onboarding and skill development conducted in person as needed. Location:
Virtual; candidates may be required to travel for in-person training as part of onboarding. Hybrid/virtual work policy applies; candidates outside reasonable commuting distance will not be considered unless an accommodation is granted by law. Hours:
Monday – Friday, 8:00 am to 6:00 pm (time zone dependent) with 1–2 Saturdays per year. Salary/Locations:
For candidates working in person or virtually in the locations below, the salary range for this position is $82,152 to $123,228. Locations: New York. Elevance Health is a Fortune 25 health company focused on improving lives and communities. Elevance Health is an Equal Employment Opportunity employer and all qualified applicants will receive consideration for employment without regard to age, citizenship status, color, creed, disability, ethnicity, genetic information, gender, marital status, national origin, race, religion, sex, sexual orientation, veteran status or any other status protected by law. Responsibilities
Review the most complex or challenging cases requiring nursing judgment, critical thinking, and holistic assessment to determine whether to approve services as medically necessary. Work with healthcare providers to understand and assess a member’s clinical picture; use nursing judgment to determine medical necessity and provide consultation to the Medical Director on unclear cases. Serve as a resource for clinicians; participate in special projects and help craft, implement, and improve organizational policies. Collaborate with case management nurses on discharge planning to ensure appropriate equipment, environment, and education for safe discharge. Provide nursing consultation to Medical Director and/or Providers on select, complex, or unclear cases; educate and support lower-level nurses. Assist with process improvement initiatives and training materials; participate in intradepartmental and cross-functional teams. Educate members about plan benefits and assist with case management as needed. Minimum Requirements
Associate’s degree in nursing; minimum of 4 years of care management or case management experience; minimum of 2 years of clinical, utilization review, or managed care experience, or equivalent combination of education and experience. Current active, valid, and unrestricted RN license and/or certification to practice within applicable state(s); multi-state licensure required if providing services in multiple states. Preferred Capabilities, Skills And Experiences
Medical Management experience preferred. Utilization Review experience preferred. Knowledge of medical management processes and ability to interpret/apply member contracts and managed care products is strongly preferred. Be advised that Elevance Health accepts resumes for compensation from agencies with a signed agreement. The company emphasizes equal pay and opportunities in accordance with applicable laws.
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