Med Mgmt Nurse (US)
Hybrid · Atlanta, Georgia, United States or Tampa, Florida, United States
Job Summary
Medical Management Nurse reviews and assesses the most complex cases to determine medical necessity, leveraging nursing judgment and clinical guidelines. The role collaborates with healthcare providers to understand a member’s clinical picture, provides consultation to the Medical Director on complex cases, supports discharge planning, educates members on plan benefits, and contributes to process improvement and policy development. The position supports hybrid/virtual work with required in-person training sessions, and requires a nursing license (RN) with multi-state licensure as needed. The work spans multiple states and includes coordination with case management nurses, clinicians, and leadership to optimize member outcomes and resource use. The posting notes a hybrid workforce, COVID-19/Flu vaccination expectations for certain roles, and a structure that may require weekly onsite presence at Elevance Health locations.
Required Qualifications
- Associate’s degree in nursing
- 4 years care management or case management experience
- 2 years clinical, utilization review, or managed care experience
- Current active, valid and unrestricted RN license
- Multi-state licensure if practicing in multiple states
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