Med Mgmt Nurse (US)

Tampa, Florida, United States

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Not SpecifiedCompensation

Junior (1 to 2 years), Mid-level (3 to 4 years)Experience Level

Full TimeJob Type

UnknownVisa

Healthcare, NursingIndustries

Requirements

Candidates should possess a current Registered Nurse (RN) license in the United States, along with a Bachelor of Science in Nursing (BSN) degree. A minimum of three years of experience as a Registered Nurse, preferably in a case management or utilization review setting, is required. Strong clinical judgment, critical thinking skills, and knowledge of medical terminology are essential.

Responsibilities

The Medical Management Nurse will review complex or challenging cases requiring nursing judgment and critical thinking to determine medical necessity, working with healthcare providers to assess member clinical presentations. They will utilize nursing judgment to evaluate treatment plans, provide consultation to the Medical Director on unclear cases, and serve as a resource for clinicians. This role involves collaborating on discharge planning, educating members about benefits, and participating in departmental teams and process improvement activities, while also potentially assisting with case management and quality audits.

Skills

Registered Nurse

Case Management

Utilization Review

Medical Necessity

Clinical Judgment

Critical Thinking

Medical Terminology

Discharge Planning

Benefits Education

Elevance Health

Integrated health services and digital platform

About Elevance Health

Elevance Health focuses on enhancing the health of individuals throughout their lives by evolving from a traditional health benefits organization into a comprehensive health partner. The company serves over 118 million people, providing support at every stage of health through an integrated approach that addresses a wide range of health needs. Their services are backed by advanced capabilities and a digital health platform that streamlines access to care. Unlike many competitors, Elevance Health emphasizes a holistic view of health, aiming to redefine health and improve community well-being. The ultimate goal is to make health improvements accessible to everyone.

Indianapolis, IndianaHeadquarters

1944Year Founded

$309.4MTotal Funding

IPOCompany Stage

Enterprise Software, Social Impact, HealthcareIndustries

10,001+Employees

Benefits

Medical, dental, & vision insurance

401(k) + match

Paid holidays

Paid Time Off

Incentive bonus programs

Stock purchase plan

Life insurance

Wellness Programs

Financial education resources

Adoption & Surrogacy Assistance

Dependent-care Flexible Spending Account (DCFSA)

Parental Leave

Parental Transition Week

Critical Caregiving Leave

Risks

Departure of CFO John Gallina may create a gap in financial leadership.

Lawsuit against CMS over MA Star Ratings could lead to financial penalties.

CareBridge integration may face operational challenges, disrupting service delivery.

Differentiation

Elevance Health integrates whole health approach with digital health platform for comprehensive care.

Acquisition of CareBridge enhances home health services within Carelon division.

Strategic partnership with Clayton, Dubilier & Rice aims to innovate primary care delivery.

Upsides

AI integration in home health services can reduce hospital readmissions and improve outcomes.

Predictive analytics support early disease detection, aligning with Elevance's whole health approach.

Telehealth expansion offers opportunities to reach more patients remotely.

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