Utilization Management / Medical Management Nurse - Ca Hmo
Elevance Health
California, US
Base: $38.34 to $69.02 ph; bonus/equity: incentive...
Hybrid
Nursing judgment and clinical assessment
Utilization management in managed care
Collaboration with healthcare providers
This role enables associates to work virtually full-time, with the exception of required in-person training sessions, providing maximum flexibility and autonomy
Job Summary
This role enables associates to work virtually full-time, with the exception of required in-person training sessions, providing maximum flexibility and autonomy.
The Medical Management Nurse is responsible for reviewing the most complex cases requiring nursing judgment to determine medical necessity and collaborating with healthcare providers and Medical Directors.
Elevance Health offers a comprehensive benefits package including incentive programs, equity stock purchase, and 401k contributions, supporting personal and professional growth.
Matching Summary
This role enables associates to work virtually full-time, with the exception of required in-person training sessions, providing maximum flexibility and autonomy.
Salary
Base: $38.34 to $69.02 per hour; Bonus/Equity: Incentive and recognition programs, equity stock purchase; Benefits: Comprehensive benefits package including 401k contribution
Skills & Requirements
Must-have
nursing judgment and clinical assessment
utilization management in managed care
collaboration with healthcare providers
case management and discharge planning
virtual work with in-person training
rotating weekends and holidays
Nice-to-have
acute inpatient clinical experience
hospital case management experience
process improvement and quality audits
training and mentoring lower-level nurses
work-life integration support
equity stock purchase and 401k benefits
Key Requirements
active unrestricted RN license in California
minimum 4 years care or case management experience
minimum 2 years clinical or utilization review experience