Nurse Medical Management

Elevance Health • Indianapolis, IN

439d • Remote

About The Position

The Nurse Medical Management position at Elevance Health is a remote role focused on collaborating with healthcare providers and members to enhance quality outcomes, optimize member benefits, and ensure effective resource utilization. The role involves conducting pre-certification, care coordination, and discharge planning to ensure compliance with medical policies and member eligibility. The Nurse will facilitate care transitions and ensure access to necessary healthcare services in a cost-effective manner.

Requirements

• Current active unrestricted RN license to practice as a health professional within the scope of practice from the state of residence.
• A minimum of 2 years acute care clinical experience.

Nice To Haves

• Willingness to obtain a compact nursing license (at the company's expense) if not already held.
• Knowledge of medical management processes and ability to interpret member contracts and benefits.
• Experience with the Medicaid population.
• Strong leadership skills.
• Strong oral, written, and interpersonal communication skills.
• Problem-solving, facilitation, and analytical skills.

Responsibilities

• Conducts pre-certification, continued stay review, care coordination, or discharge planning for appropriateness of treatment setting reviews.
• Ensures member access to medically necessary, quality healthcare in a cost-effective setting according to contract.
• Consults with clinical reviewers and/or medical directors to ensure medically appropriate, high-quality, cost-effective care throughout the medical management process.
• Collaborates with providers to assess member's needs for early identification and proactive planning for discharge.
• Facilitates member care transition through the healthcare continuum and refers treatment plans to clinical reviewers as required.
• Facilitates accreditation by understanding and applying accrediting and regulatory requirements and standards.

Benefits

• 401(k) matching
• Dental insurance
• Disability insurance
• Employee stock purchase plan
• Health insurance
• Life insurance
• Paid holidays

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Industry: Insurance Carriers and Related Activities
• Education Level: No Education Listed
• Number of Employees: 5,001-10,000 employees