Medical Management Nurse Lead

Elevance Health • Austin, ID

32d • Remote

About The Position

Medical Management Nurse Lead Location: This role enables associates to work virtually full-time, with the exception of required in-person training sessions, providing maximum flexibility and autonomy. This approach promotes productivity, supports work-life integration, and ensures essential face-to-face onboarding and skill development. Please note that per our policy on hybrid/virtual work, candidates not within a reasonable commuting distance from the posting location(s) will not be considered for employment, unless an accommodation is granted as required by law. Hours: Monday - Friday 8:00am to 5:00pm depending on your time zone and occasional weekends. AmeriBen is a proud member of the Elevance Health family of companies. We are a third-party administrator (TPA) of medical benefits, including medical management. The Medical Management Nurse Lead in addition to the responsibilities of the Medical Management Nurse role, is responsible for serving as the team lead, coach, and technical resource for a team of either Medical Management Nurses or Medical Management Clinicians. Contributes on hiring, promotion, and other job-progression decisions for the nurses on their team. Works on special projects and helps to craft, implement, and improve organizational policies. Serves as the subject matter expert and department liaison to other areas of the business unit or as the representative on enterprise initiatives. How you will make an impact: Identifies the need for, and driving the execution of, process or policy improvements. Coordinates team members to ensure appropriate coverage. Provides valuable recommendations in hiring decisions, as well as promotions. Serves as a resource to lower-level nurses and clinicians. Provides training for staff. Improves materials used in orientation and training efforts. Completes quality audits and helps to develop and implement associated corrective action plans. Leads or participates on cross-functional teams, special projects, initiatives, and process improvement activities. Assists team members, as appropriate, with review of the most challenging and complex cases, as well as overflow cases. Works with healthcare providers to promote quality member outcomes, to optimize member benefits and promote effective use of resources. Consults with team members and Medical Directors to ensure medically appropriate, high-quality, cost-effective services.

Requirements

• Requires a minimum of associate’s degree in nursing.
• Requires a minimum of 6 years care management or case management experience and requires a minimum of 2 years clinical, utilization review, or managed care experience; or any combination of education and experience, which would provide an equivalent background.
• Current active, valid and unrestricted RN license and/or certification to practice as a health professional within the scope of licensure in applicable state(s) or territory of the United States required.
• Multi-state licensure is required if this individual is providing services in multiple states.

Nice To Haves

• Prior healthcare third party vendor (TPA) experience.
• Leadership experience.

Responsibilities

• Identifies the need for, and driving the execution of, process or policy improvements.
• Coordinates team members to ensure appropriate coverage.
• Provides valuable recommendations in hiring decisions, as well as promotions.
• Serves as a resource to lower-level nurses and clinicians.
• Provides training for staff.
• Improves materials used in orientation and training efforts.
• Completes quality audits and helps to develop and implement associated corrective action plans.
• Leads or participates on cross-functional teams, special projects, initiatives, and process improvement activities.
• Assists team members, as appropriate, with review of the most challenging and complex cases, as well as overflow cases.
• Works with healthcare providers to promote quality member outcomes, to optimize member benefits and promote effective use of resources.
• Consults with team members and Medical Directors to ensure medically appropriate, high-quality, cost-effective services.

Benefits

• a comprehensive benefits package
• incentive and recognition programs
• equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements)

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: Associate degree