Medical Management Nurse, California

🔥 0 minutes ago

🏄 California – Remote

🏄 California – Remote

💵 $41 - $69 / hour

⏰ 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 complex and challenging cases requiring nursing judgment, critical thinking, and holistic assessment • Determine whether requested services are medically necessary and approve services when appropriate • Analyze members’ clinical information and apply clinical guidelines and organizational policies • Interface and collaborate with healthcare providers to assess members’ clinical presentations • Promote quality member outcomes, optimize member benefits, and support effective resource use • Identify abnormalities and inappropriate type, level, or quality of care • Provide consultation to the Medical Director on peculiar, complex, unclear, or noncompliant cases • Recommend alternate types, places, or levels of appropriate care • Collaborate with case management nurses on discharge planning and safe discharge needs • Serve as a resource to lower-level nurses • Participate in intradepartmental and cross-functional teams, projects, initiatives, and process improvement • Educate members about plan benefits and physicians and assist with case management • Enhance training and orientation materials with leadership • Complete quality audits and assist with corrective action plans • Support process improvement initiatives • Help 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 • Equivalent combination of education and experience may be considered • Current active, valid and unrestricted RN license to practice as a health professional within the scope of licensure in California • Strong acute, inpatient clinical experience in areas such as Med/Surg, Critical Care, ER, Telemetry, etc. strongly preferred • Utilization management/review within managed care or hospital strongly preferred • Ability to work an 8-hour shift between 7:30am and 6pm PST • Ability to work rotating weekends and holidays • Candidates must reside within a reasonable commuting distance from the posting location(s), unless an accommodation is granted as required by law • Candidates in patient/member-facing roles may be required to become vaccinated against COVID-19 and Influenza

🏖️ Benefits

• Comprehensive benefits package • Incentive and recognition programs • Equity stock purchase • 401k contribution / 401(k) + match • Merit increases • Paid holidays • Paid Time Off • Incentive bonus programs • Medical benefits • Dental benefits • Vision benefits • Short-term disability benefits • Long-term disability benefits • Stock purchase plan • Life insurance • Wellness programs • Financial education resources • COVID-19 and Influenza vaccination coverage/requirement for certain roles