Medical Management Nurse – Weekends

🔥 0 minutes ago

🐊 Florida – Remote

🐊 Florida – Remote

⏰ Full Time

🟡 Mid-level

🟠 Senior

🦅 H1B Visa Sponsor

This company has sponsored H1B visas in the past.

👻 Ghost score 10%

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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 • Work with healthcare providers to understand and assess members’ clinical presentations • Provide consultation to the 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 resource utilization • Assess complex clinical concepts, symptoms, and aggregate member information • Identify inappropriate type, level, or quality of care • Recommend alternate types, places, or levels of appropriate care • Collaborate with case management nurses on discharge planning • Ensure patients have appropriate equipment, environment, and education for safe discharge • Participate in intradepartmental and 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 leadership and stakeholders with process improvement initiatives • Help train lower-level clinician staff

🎯 Requirements

• Minimum associate’s degree in nursing • Minimum 4 years of care management or case management experience • Minimum 2 years of clinical, utilization review, or managed care experience • Equivalent combination of education and experience may be accepted • 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 if providing services in multiple states • Candidates must reside in the state of Florida • Ability to work 4/10s Saturday-Tuesday, 7AM-6PM EST • 3 holidays per year • COVID-19 and Influenza vaccination required for certain patient/member-facing roles unless an acceptable explanation is provided • Ability to attend required in-person training sessions • Must be within a reasonable commuting distance from the posting location(s), unless an accommodation is granted as required by law

🏖️ Benefits

• 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) match • Stock purchase plan • Life insurance • Wellness programs • Financial education resources • Virtual full-time work, except for required in-person training sessions • Work-life integration and flexibility • Training and orientation opportunities