RN Nurse Medical Mgmt Sr.

3 weeks ago

Houston, United States Elevance Health Full time

LOCATION : This is a remote position; however, you must be within 50 miles of an eligible Elevance Health office.

HOURS : An 8 hour shift between 6 am and 6 pm, CST. Weekend and holiday coverage is rotated among the team. ​

The Nurse Medical Mgmt Sr. is responsible to serve as team lead for nursing staff who collaborate with healthcare providers and members to promote quality member outcomes, to optimize member benefits, and to promote effective use of resources for the most complex or elevated medical issues.

Primary duties may include, but are not limited to:

  • Continued stay review, care coordination, and discharge planning for appropriateness of treatment setting reviews to ensure compliance with applicable criteria, medical policy, and member eligibility, benefits, and contracts.

  • Conducts precertification, continued stay review, care coordination, or discharge planning for appropriateness of treatment setting reviews to ensure compliance with applicable criteria, medical policy, and member eligibility, benefits, and contracts.

  • Ensures member access to medical necessary, quality healthcare in a cost effective setting according to contract.

  • Consult 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 members needs for early identification of and proactive planning for discharge planning.

  • Facilitates member care transition through the healthcare continuum and refers treatment plans/plan of care to clinical reviewers as required and does not issue non-certifications.

  • Facilitates accreditation by knowing, understanding, correctly interpreting, and accurately applying accrediting and regulatory requirements and standards.

  • Ensures consistency in benefit application.

  • May lead cross-functional teams, projects, initiatives, and process improvement activities.

  • May serve as departmental liaison to other areas of the business unit or as representative on enterprise initiatives.

Required Qualifications

  • 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.

  • Requires a HS diploma or equivalent and a minimum of 3 years acute care clinical experience or case management, utilization management or managed care experience; or any combination of education and experience, which would provide an equivalent background.

  • Prior managed care experience required.

Preferred Qualifications

  • Knowledge of medical management process and ability to interpret and apply member contracts, member benefits, and managed care products strongly preferred.

  • Experience working with the Medicaid population is strongly preferred.

  • Previous leadership skills strongly preferred.

  • Associates in this role are expected to have strong oral, written and interpersonal communication skills, problem-solving skills, facilitation skills, and analytical skills.

Please be advised that Elevance Health only accepts resumes for compensation from agencies that have a signed agreement with Elevance Health. Any unsolicited resumes, including those submitted to hiring managers, are deemed to be the property of Elevance Health.

Who We Are

Elevance Health is a health company dedicated to improving lives and communities – and making healthcare simpler. We are a Fortune 25 company with a longstanding history in the healthcare industry, looking for leaders at all levels of the organization who are passionate about making an impact on our members and the communities we serve.

How We Work

At Elevance Health, we are creating a culture that is designed to advance our strategy but will also lead to personal and professional growth for our associates. Our values and behaviors are the root of our culture. They are how we achieve our strategy, power our business outcomes and drive our shared success - for our consumers, our associates, our communities and our business.

We offer a range of market-competitive total rewards that include merit increases, paid holidays, Paid Time Off, and incentive bonus programs (unless covered by a collective bargaining agreement), medical, dental, vision, short and long term disability benefits, 401(k) +match, stock purchase plan, life insurance, wellness programs and financial education resources, to name a few.

Elevance Health operates in a Hybrid Workforce Strategy. Unless specified as primarily virtual by the hiring manager, associates are required to work at an Elevance Health location at least once per week, and potentially several times per week. Specific requirements and expectations for time onsite will be discussed as part of the hiring process. Candidates must reside within 50 miles or 1-hour commute each way of a relevant Elevance Health location.

The health of our associates and communities is a top priority for Elevance Health. We require all new candidates in certain patient/member-facing roles to become vaccinated against COVID-19. If you are not vaccinated, your offer will be rescinded unless you provide an acceptable explanation. Elevance Health will also follow all relevant federal, state and local laws.

Elevance Health is an Equal Employment Opportunity employer and all qualified applicants will receive consideration for employment without regard to age, citizenship status, color, creed, disability, ethnicity, genetic information, gender (including gender identity and gender expression), marital status, national origin, race, religion, sex, sexual orientation, veteran status or any other status or condition protected by applicable federal, state, or local laws. Applicants who require accommodation to participate in the job application process may contact elevancehealthjobssupport@elevancehealth.com for assistance.

  • Staff Nurse, RN Medical Oncology

    3 months ago

    Houston, TX, United States Houston Methodist Specialty Physician Group Full time

    At Houston Methodist, the Sr Staff Registered Nurse (RN) position is responsible for functioning as an advanced clinician at the Proficient level according to Benner's model of clinical practice. The Sr Staff RN position provides professional direct patient nursing care to a diverse patient population, which may include patients with varied and complex...

  • Sr Medical Assistant

    2 weeks ago

    Houston, United States Houston Methodist Specialty Physician Group Full time

    At Houston Methodist, the Senior Medical Assistant Non-Certified (Sr. MA) position is responsible for functioning as an expert and demonstrates highly competent knowledge in the more technical and advances examinations and treatments necessary to communicate appropriately and carry out delegated medical assistant level tasks under the direct supervision of a...

  • Sr Medical Assistant Certified

    4 months ago

    Houston, United States Houston Methodist Hospital Full time

    At Houston Methodist, the Senior Medical Assistant Certified (Sr. MA) position is responsible for functioning as an expert and demonstrates highly competent knowledge in the more technical and advances examinations and treatments necessary to communicate appropriately and carry out delegated medical assistant level tasks under the direct supervision of a...

  • Travel Nurse RN

    2 weeks ago

    Houston, United States Infojini Healthcare Full time

    ID: 50464563 Shift: 12 HR Nights 19:00-07:00 Description: Job Specific Notes: RN Supervisor Labor DeliveryJOB SUMMARYThe Supervisor, Nursing Registered Nurse (RN) is responsible for supervision of assigned nursing and unit-based personnel to provide a safe, caring environment for patients, family and staff which fosters professional nursing practice, shared...

  • Travel Nurse RN Position

    1 month ago

    Houston, Texas, United States Nurse First Full time

    Nurse First is seeking a skilled Cardiac Cath Lab RN for a travel nursing assignment in a dynamic healthcare environment.Job DetailsSpecialty: Cardiac Cath LabDiscipline: RNEmployment Type: TravelNurse First offers a competitive pay package and comprehensive benefits, including holiday pay, guaranteed hours, and mileage reimbursement.About Nurse FirstNurse...

  • Sr Medical Assistant

    2 weeks ago

    Houston, TX, United States Houston Methodist Specialty Physician Group Full time

    At Houston Methodist, the Senior Medical Assistant Non-Certified (Sr. MA) position is responsible for functioning as an expert and demonstrates highly competent knowledge in the more technical and advances examinations and treatments necessary to communicate appropriately and carry out delegated medical assistant level tasks under the direct supervision of a...

  • Sr Medical Assistant Certified

    4 weeks ago

    Houston, TX, United States Houston Methodist Specialty Physician Group Full time

    At Houston Methodist, the Senior Medical Assistant Certified (Sr. MA) position is responsible for functioning as an expert and demonstrates highly competent knowledge in the more technical and advances examinations and treatments necessary to communicate appropriately and carry out delegated medical assistant level tasks under the direct supervision of a...

  • Registered Nurse RN IMCU

    2 months ago

    Houston, United States HCA Houston Healthcare Medical Center Full time

    Description IntroductionAre you looking for a place to deliver excellent care patients deserve? At HCA Houston Healthcare Medical Center we support our colleagues in their positions. Join our Team as a(an) Registered Nurse RN IMCU and access programs to assist with every stage of your career.BenefitsHCA Houston Healthcare Medical Center, offers a total...

  • Travel Nurse RN Position

    2 weeks ago

    Houston, Texas, United States Nurse First Full time

    We are seeking a skilled Registered Nurse for a travel assignment in Labor and Delivery. This is a great opportunity to gain experience and work with a dedicated team at Nurse First.Job DetailsSpecialty: Labor and DeliveryDiscipline: RNEmployment Type: TravelShift: 12 hours, nightsAt Nurse First, we offer a competitive pay package, tax-free stipend, and a...

  • Senior Staff Registered Nurse- Cardiology

    3 months ago

    Houston, United States HealthEcareers - Client Full time

    At Houston Methodist, the Sr Staff Registered Nurse (RN) position is responsible for functioning as an advanced clinician at the Proficient level according to Benner's model of clinical practice. The Sr Staff RN position provides professional direct patient nursing care to a diverse patient population, which may include patients with varied and complex...

  • Surgical Technologist

    4 weeks ago

    Houston, Texas, United States Houston Methodist Sugar Land Hospital Full time

    Job Summary:We are seeking a highly skilled Sr Surgical Technologist to join our team at Houston Methodist Sugar Land Hospital. As a Sr Surgical Technologist, you will play a critical role in ensuring the smooth operation of our operating rooms and providing exceptional patient care.Key Responsibilities:Prepare the operating room, equipment, and supplies for...

  • Pcu Nurse

    1 month ago

    Houston, Texas, United States RN-Staff Full time

    Job Title: PCU RNSeeking a highly skilled and experienced Registered Nurse to join our team at RN-Staff. This is a challenging and rewarding opportunity to work in a dynamic PCU environment.Job Summary:We are looking for a dedicated and compassionate Registered Nurse to provide high-quality patient care in our PCU department. The ideal candidate will have a...

  • Registered Nurse RN IMCU

    3 weeks ago

    Houston, United States HCA Houston Healthcare Medical Center Full time

    Description IntroductionDo you currently have an opportunity to make a real impact with your work? With over 2,000 sites of care and serving over 31.2 million patient interactions every year, nurses at HCA Houston Healthcare Medical Center have the opportunity to make a real impact. As a(an) Registered Nurse RN IMCU you can be a part of change.BenefitsHCA...

  • Medical Care Unit RN

    2 weeks ago

    houston, United States Travel Nurse Across America Full time

    Travel Nurse Across America is seeking a qualified Neonatal intensive care RN needed for travel nurse assignment in Houston, TX. This assignment is in a Traveler-friendly facility and offers excellent pay, benefits, bonus opportunity, travel reimbursement, all licenses and certifications paid and more! Minimum 1-2 years’ experience...

  • Registered Nurse RN IMCU

    4 weeks ago

    Houston, United States HCA Houston Healthcare Medical Center Full time

    Description IntroductionDo you currently have an opportunity to make a real impact with your work? With over 2,000 sites of care and serving over 31.2 million patient interactions every year, nurses at HCA Houston Healthcare Medical Center have the opportunity to make a real impact. As a(an) Registered Nurse RN IMCU you can be a part of change.BenefitsHCA...

  • Registered Nurse RN IMCU

    4 weeks ago

    Houston, United States HCA Houston Healthcare Medical Center Full time

    Description IntroductionDo you currently have an opportunity to make a real impact with your work? With over 2,000 sites of care and serving over 31.2 million patient interactions every year, nurses at HCA Houston Healthcare Medical Center have the opportunity to make a real impact. As a(an) Registered Nurse RN IMCU you can be a part of change.BenefitsHCA...

  • Travel Nurse RN

    2 weeks ago

    Houston, United States Infojini Healthcare Full time

    ID: 51713336 Shift: 12 HR Nights 19:00-07:00 Description: Job Specific Notes: Postpartum Manager RN Nights Austin, TXShift: Nights (no weekends)Job SummaryThe Manager ensures high quality, patient-centered care through oversight of the overall daily function and staffing of the unit/department. The Manager monitors and evaluates the provision of nursing care...

  • Registered Nurse RN Endoscopy PRN

    4 weeks ago

    Houston, United States HCA Houston Healthcare Medical Center Full time

    Description IntroductionDo you have the PRN career opportunities as a(an) Registered Nurse RN Endoscopy PRN you want with your current employer? We have an exciting opportunity for you to join HCA Houston Healthcare Medical Center which is part of the nation's leading provider of healthcare services, HCA Healthcare.BenefitsHCA Houston Healthcare Medical...

  • Registered Nurse RN IMCU

    4 weeks ago

    Houston, United States HCA Houston Healthcare Medical Center Full time

    Description IntroductionDo you currently have an opportunity to make a real impact with your work? With over 2,000 sites of care and serving over 31.2 million patient interactions every year, nurses at HCA Houston Healthcare Medical Center have the opportunity to make a real impact. As a(an) Registered Nurse RN IMCU you can be a part of change.BenefitsHCA...

  • Travel Nurse RN

    4 weeks ago

    Houston, United States Trustaff Full time

    About this jobAs a Case Management RN, you'll develop, implement, and evaluate individual patient care plans. You'll work with patients one-on-one to manage their care appropriately and affordably. Case Managers are important liaison, and you'll serve as a link between patients, their families, and healthcare providers.Qualifications:Basic travel nursing...