Elevance Health
Job Title: Med Mgmt Nurse (US)
Location: Washington, DC. The role requires associates to work in-office 4 days per week while offering flexibility for remote work. Alternate locations may be considered.
The Medical Management Nurse will review complex or challenging cases that require nursing judgment, critical thinking, and holistic assessment. The nurse interfaces with healthcare providers to evaluate a member’s clinical presentation, determine medical necessity, and provide consultation to the Medical Director on unclear or critical cases. The role also supports case management and contributes to organizational policy improvement and special projects.
How You Will Make An Impact
Utilizes nursing judgment and reasoning to analyze members’ clinical information, interface with healthcare providers, and apply clinical guidelines to evaluate medical necessity.
Works with healthcare providers to promote quality member outcomes, optimize benefits, and ensure effective use of resources.
Determines and assesses abnormalities by understanding complex clinical concepts and evaluating members’ symptoms.
Recognizes when a member may not be receiving appropriate care and addresses discrepancies with the provider.
Provides consultation to the Medical Director on particularly complex cases.
Recommends alternative care options based on critical thinking skills and nursing judgment.
Collaborates with case management nurses on discharge planning, ensuring proper equipment and education for safe discharge.
Provides nursing consultation to the Medical Director or provider for select complex, concerning, or unclear cases.
Serves as a resource to lower-level nurses.
Participates in intradepartmental teams, cross‑functional projects, and process improvement activities.
Educates members about plan benefits and physicians, and may assist with case management.
Collaborates with leadership to enhance training and orientation materials.
Completes quality audits and assists management with corrective action plans.
Supports process improvement initiatives with leadership and other stakeholders.
Assists in training lower-level clinician staff.
Minimum Requirements
Associate’s degree in nursing and a minimum of 4 years of care management or case management experience.
Minimum of 2 years of clinical, utilization review, or managed care experience (or an equivalent combination of education and experience).
Current active, valid, and unrestricted RN license (or equivalent) in the applicable state(s).
Multi‑state licensure is required if services are provided in multiple states.
Salary Salary range: $89,976 – $134,964 (subject to location, experience, and qualifications).
Benefits
Comprehensive benefits package including medical, dental, vision, and disability coverage.
401(k) with employer match and equity stock purchase program.
Incentive and recognition programs.
Paid time off, holidays, and paid annual leave.
Continuous professional development and training opportunities.
Equal Employment Opportunity Elevance Health is an Equal Employment Opportunity employer. All qualified applicants will receive consideration for employment without regard to age, gender, race, disability, religious, or other protected status. In accordance with all applicable federal, state, and local laws, including Fair Chance and Fair Chance Act provisions, qualified applicants with arrest or conviction records will be considered for employment.
Contact For accommodation assistance or further information, contact
evidencehealthjobssupport@elevancehealth.com .
#J-18808-Ljbffr
The Medical Management Nurse will review complex or challenging cases that require nursing judgment, critical thinking, and holistic assessment. The nurse interfaces with healthcare providers to evaluate a member’s clinical presentation, determine medical necessity, and provide consultation to the Medical Director on unclear or critical cases. The role also supports case management and contributes to organizational policy improvement and special projects.
How You Will Make An Impact
Utilizes nursing judgment and reasoning to analyze members’ clinical information, interface with healthcare providers, and apply clinical guidelines to evaluate medical necessity.
Works with healthcare providers to promote quality member outcomes, optimize benefits, and ensure effective use of resources.
Determines and assesses abnormalities by understanding complex clinical concepts and evaluating members’ symptoms.
Recognizes when a member may not be receiving appropriate care and addresses discrepancies with the provider.
Provides consultation to the Medical Director on particularly complex cases.
Recommends alternative care options based on critical thinking skills and nursing judgment.
Collaborates with case management nurses on discharge planning, ensuring proper equipment and education for safe discharge.
Provides nursing consultation to the Medical Director or provider for select complex, concerning, or unclear cases.
Serves as a resource to lower-level nurses.
Participates in intradepartmental teams, cross‑functional projects, and process improvement activities.
Educates members about plan benefits and physicians, and may assist with case management.
Collaborates with leadership to enhance training and orientation materials.
Completes quality audits and assists management with corrective action plans.
Supports process improvement initiatives with leadership and other stakeholders.
Assists in training lower-level clinician staff.
Minimum Requirements
Associate’s degree in nursing and a minimum of 4 years of care management or case management experience.
Minimum of 2 years of clinical, utilization review, or managed care experience (or an equivalent combination of education and experience).
Current active, valid, and unrestricted RN license (or equivalent) in the applicable state(s).
Multi‑state licensure is required if services are provided in multiple states.
Salary Salary range: $89,976 – $134,964 (subject to location, experience, and qualifications).
Benefits
Comprehensive benefits package including medical, dental, vision, and disability coverage.
401(k) with employer match and equity stock purchase program.
Incentive and recognition programs.
Paid time off, holidays, and paid annual leave.
Continuous professional development and training opportunities.
Equal Employment Opportunity Elevance Health is an Equal Employment Opportunity employer. All qualified applicants will receive consideration for employment without regard to age, gender, race, disability, religious, or other protected status. In accordance with all applicable federal, state, and local laws, including Fair Chance and Fair Chance Act provisions, qualified applicants with arrest or conviction records will be considered for employment.
Contact For accommodation assistance or further information, contact
evidencehealthjobssupport@elevancehealth.com .
#J-18808-Ljbffr