Med Mgmt Nurse (US)
Elevance Health(1 month ago)
About this role
The Medical Management Nurse reviews complex clinical cases to determine medical necessity, consults with providers and the Medical Director, and serves as a clinical resource within the organization. The role supports member outcomes and utilization management through holistic clinical assessment, coordination with case management, and participation in process improvement and training activities.
Required Skills
- Nursing Judgment
- Clinical Assessment
- Utilization Review
- Case Management
- Discharge Planning
- Provider Communication
- Quality Assurance
- Training
- Policy Implementation
Qualifications
- Associate's Degree in Nursing
- Active Unrestricted RN License
- Multi-State Licensure (if practicing in multiple states)
- American Association of Managed Care Nurses Certification (preferred)
About Elevance Health
elevancehealth.comElevance Health, formerly Anthem, Inc., serves people across their entire health journey taking an integrated whole-health approach.
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