Medical Management Nurse, CA Licensed

🔥 13 hours ago

🏄 California, Nevada – Remote

🏄 California – Remote 🎰 Nevada – Remote

💵 $83.7k - $143.6k / year

⏰ Full Time

🟡 Mid-level

🟠 Senior

🦅 H1B Visa Sponsor

This company has sponsored H1B visas in the past.

👻 Ghost score 0%

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Elevance Health

WebsiteLinkedInAll Job Openings

10,000+ employees

🏥 Healthcare

⚕️ Healthcare Insurance

🤝 B2B

Healthcare • Healthcare Insurance • B2B

Elevance Health is transforming from a traditional health benefits organization into a lifetime trusted health partner, driven by a bold purpose to improve the health of humanity. With nearly 100,000 associates, they serve over 118 million people and utilize an integrated whole health approach supported by industry-leading capabilities and a digital health platform. Their mission includes redefining health, reimagining the health system, and strengthening communities.

📋 Description

• Review the most complex or challenging cases requiring nursing judgment, critical thinking, and holistic assessment • Determine whether requested services are medically necessary • Work with healthcare providers to understand and assess members’ clinical pictures • Provide consultation to Medical Director on unclear or complex cases • Serve as a resource for clinicians and lower-level nurses • Analyze members’ clinical information and apply clinical guidelines and policies to evaluate medical necessity • Promote quality member outcomes, optimize member benefits, and support effective use of resources • Assess complex clinical concepts, symptoms, and aggregate member information • Identify when members may not be receiving appropriate type, level, or quality of care • Recommend alternate types, places, or levels of appropriate care • Collaborate with case management nurses on discharge planning • Collaborate with and provide nursing consultation to Medical Director and/or providers • Participate in intradepartmental teams, cross-functional teams, projects, initiatives, and process improvement activities • Educate members about plan benefits and physicians and assist with case management • Collaborate with leadership to enhance training and orientation materials • Complete quality audits and assist with corrective action plans • Assist with process improvement initiatives • Train lower-level clinician staff

🎯 Requirements

• Minimum associate’s degree in nursing • Minimum of 4 years care management or case management experience • Minimum of 2 years clinical, utilization review, or managed care experience • 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 • Multi-state licensure required when providing services in multiple states • Proficient in Microsoft Office Suite or Microsoft 365 is strongly preferred • Minimum of 2 years working in an inpatient acute care hospital environment highly preferred • Ability to work 8:00 AM to 6:00 PM Pacific time • Must reside within a reasonable commuting distance from a posting location unless accommodation is granted as required by law

🏖️ Benefits

• Comprehensive benefits package • Incentive and recognition programs • Equity stock purchase • 401k contribution • Merit increases • Paid holidays • Paid Time Off • Incentive bonus programs • Medical benefits • Dental benefits • Vision benefits • Short-term disability benefits • Long-term disability benefits • 401(k) with match • Stock purchase plan • Life insurance • Wellness programs • Financial education resources • Virtual full-time work arrangement, except required in-person training sessions • Overtime pay for associates working from a California location, based on California employment law