Med Mgmt Nurse (us)

Elevance Health

Washington, DC, United States
Base: $89,976 to $134,964; bonus/equity: incentive...
Hybrid
Nursing judgment and critical thinking
In-person collaboration and teamwork
Clinical case review and assessment
The Medical Management Nurse is responsible for reviewing complex cases requiring nursing judgment to determine medical necessity and consult with Medical Directors

Job Summary

  • The Medical Management Nurse is responsible for reviewing complex cases requiring nursing judgment to determine medical necessity and consult with Medical Directors.
  • Elevance Health offers a comprehensive benefits package including incentive programs, equity stock purchase, and 401(k) contributions, supporting personal and professional growth.
  • The company fosters a culture based on values and behaviors that drive business outcomes and shared success for consumers, associates, and communities.

Matching Summary

The Medical Management Nurse is responsible for reviewing complex cases requiring nursing judgment to determine medical necessity and consult with Medical Directors.

Salary

Base: $89,976 to $134,964; Bonus/Equity: Incentive and recognition programs, equity stock purchase; Benefits: Comprehensive benefits package including 401(k) match, medical, dental, vision

Skills & Requirements

Must-have

  • Nursing judgment and critical thinking
  • In-person collaboration and teamwork
  • Clinical case review and assessment
  • Healthcare provider consultation
  • Medical necessity determination
  • Discharge planning collaboration

Nice-to-have

  • Process improvement participation
  • Training and orientation enhancement
  • Quality audits and corrective plans
  • Member education and case management support
  • Cross-functional team collaboration

Key Requirements

  • Associate’s degree in nursing
  • Minimum 4 years care or case management experience
  • Minimum 2 years clinical or utilization review experience
  • Active, valid, unrestricted RN license
  • Multi-state licensure if servicing multiple states

Work Rights

Valid RN license and compliance with state licensure requirements

Tailored Resume

Cover Letter