Med Mgmt Nurse
Elevance Health · Chicago, IL · Yesterday
Healthcare$84k–$132k/yrFull-time
About the role
The Medical Management Nurse role is designed to enable associates to work virtually full-time, with occasional in-person training sessions. This flexible arrangement supports productivity, work-life integration, and essential onboarding and skill development.
Responsibilities
- Review and assess the most complex or challenging cases requiring nursing judgment and holistic assessment.
- Work with healthcare providers to understand and assess a member’s clinical picture.
- Determine whether treatment is medically necessary and provide consultation to the Medical Director on unclear or ambiguous cases.
- Act as a resource for clinicians and collaborate on discharge planning.
- Collaborate with case management nurses on discharge planning and ensure patients have appropriate equipment, environment, and education.
- Provide nursing consultation to the Medical Director and/or provider on complex or unclear cases.
- Educate members about plan benefits and assist with case management.
- Participate in training and orientation materials enhancement.
- Contribute to quality audits and assist in developing corrective action plans.
- Support process improvement initiatives.
Requirements
- Minimum Associate’s degree in Nursing.
- Minimum 4 years of managed care experience, including 2 years in clinical, utilization review, or case management.
- Current active, unrestricted RN license and/or certification in applicable state(s) or territory of the United States.
Preferred Skills, Capabilities & Experiences
- Utilization management experience.
- Strong computer skills.
Benefits
- Comprehensive benefits package.
- Incentive and recognition programs.
- Equity stock purchase program.
- 401(k) matching.
Pay
The salary range for this specific position is $83,748 to $131,604, subject to geographic location, work experience, education, and skill level. The salary offered is based on a number of legitimate, non-discriminatory factors set by the Company.
Schedule
Hours: Tuesday-Saturday 8:30am-5pm EST.