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Medical Management Nurse job at Elevance Health | Apply Now
Are you looking for Remote Medical / Health Care jobs 2025 today? then you might be interested in Medical Management Nurse job at Elevance Health
Remote, OR, USA
Full Time
About the Organisation
Elevance Health is fueled by a purpose to strengthen the health of humanity by redefining health, reimagining the health system, and improving communities. Recognized on the Fortune 100 Best Companies to Work For list, among other achievements, Elevance describes itself as an employer of choice for thousands of associates across the United States. In times of growth, the company has invited individuals with diverse backgrounds to join its team of innovative, compassionate colleagues in a mission-driven environment of collaboration, limitless growth opportunities, an inclusive spirit, and personal and professional support. In the past, Elevance has posted medical & health, dental, business development, pharmacy technician, insurance, computer & IT, and account management jobs, among others, featuring hybrid to 100% remote flexibility and part-time schedules. The employer also offers benefits to eligible associates and provides a range of programs designed to help team members stay healthy.
In business since 1944, Elevance Health was formerly known as Anthem, Inc. before the company changed names in 2022 to reflect its transition from a traditional health benefits organization to a "lifetime trusted health partner." Specifically, the company is working to reimagine the health system by taking a more holistic, integrated approach to improve outcomes, accessibility, and equity. This approach is powered by a digital platform, industry-leading capabilities, and a team of nearly 100,000 associates who serve more than 118 million people. Elevance Health is guided by values of leadership, community, integrity, agility, and diversity. In line with its overall mission, it runs the Elevance Health Foundation and strives to be a responsible corporate citizen to shape the company, communities, and the world for the better.
Headquarters
Indianapolis, Indiana
Job Title
Medical Management Nurse job at Elevance Health
Elevance Health
Job Description
The Medical Management Nurse evaluates members’ clinical information, interfaces with healthcare providers, and applies clinical guidelines to assess medical necessity. The role includes case management, quality assurance, policy development, and collaboration with internal teams to optimize patient outcomes. Responsibilities extend to special projects, policy improvement, and training support.
Duties, Roles and Responsibilities
Analyze and assess members' clinical information, applying nursing judgment and clinical guidelines.
Work with healthcare providers to promote quality outcomes, optimize benefits, and ensure appropriate care.
Identify abnormalities in members' conditions and assess symptoms holistically.
Determine if treatments align with diagnoses and intervene if necessary.
Consult with Medical Directors for complex or unclear cases.
Recommend alternative care plans based on nursing judgment.
Collaborate with case management teams on discharge planning.
Serve as a resource for lower-level nurses and provide training support.
Participate in process improvement initiatives and assist with quality audits.
Educate members on plan benefits and coordinate case management services.
SERVICES
COMMERCIAL
SERVICES
INDUSTRIAL
SERVICES
RESIDENTIAL
SERVICES
COMMERCIAL
SERVICES
INDUSTRIAL
SERVICES
RESIDENTIAL
SERVICES
COMMERCIAL
SERVICES
COMMERCIAL
SERVICES
COMMERCIAL
SERVICES
COMMERCIAL
SERVICES
INDUSTRIAL
SERVICES
RESIDENTIAL
Qualifications, Education and Competencies
Associate’s degree in nursing required.
Minimum of 4 years in care or case management, with at least 2 years in clinical utilization review or managed care.
Active, valid, and unrestricted RN license in the applicable state(s) or U.S. territory.
Multi-state licensure required if providing services in multiple states.
Strong critical thinking, problem-solving, and communication skills.
Experience in policy development, case reviews, and provider collaboration.
How to Apply
ONLINE APPLICATION ONLY!
Interested candidates are advised that applications for this position must be submitted online. To apply, please click on the "Apply" button below.
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