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Elevance Health
posted about 2 months ago
About the position
The Nurse Medical Management I role at Elevance Health is focused on collaborating with healthcare providers and members to ensure quality member outcomes and optimize the use of healthcare resources. This position involves assessing the medical necessity of various healthcare services, ensuring compliance with medical policies, and facilitating care transitions for members. The role is part-time, primarily on weekends, and requires a strong clinical background in acute care settings.
Responsibilities
- Conducts pre-certification, continued stay review, care coordination, or discharge planning for appropriateness of treatment setting reviews.
- Ensures member access to medically necessary, quality healthcare in a cost-effective setting according to contract.
- Consults with clinical reviewers and/or medical directors to ensure medically appropriate, high-quality, cost-effective care throughout the medical management process.
- Collaborates with providers to assess member's needs for early identification and proactive planning for discharge.
- Facilitates member care transition through the healthcare continuum and refers treatment plans to clinical reviewers as required.
- Facilitates accreditation by understanding and applying accrediting and regulatory requirements.
Requirements
- Requires a HS diploma or equivalent.
- Requires current active valid unrestricted RN license to practice as a health professional within the scope of practice in applicable state(s) or territory of the United States.
- Minimum of 2 years acute care clinical experience.
Nice-to-haves
- Prior experience in inpatient Utilization Management, preferred.
- 3-5 years of experience in a hospital setting (ER, ICU, MedSurg, preferred).
- Knowledge and/or experience of MCO, preferred.
Benefits
- Merit increases
- Paid holidays
- Paid Time Off
- Incentive bonus programs
- Medical insurance
- Dental insurance
- Vision insurance
- Short and long term disability benefits
- 401(k) with matching
- Stock purchase plan
- Life insurance
- Wellness programs
- Financial education resources
