Healthcare Professional with Advanced Nursing Skills

1 week ago


Woodland Hills, California, United States Elevance Health Full time
Healthcare Professional with Advanced Nursing Skills

Elevance Health is seeking a skilled Healthcare Professional with Advanced Nursing Skills to join our team. In this role, you will be responsible for reviewing complex cases and making decisions on medical necessity. You will work closely with healthcare providers to understand and assess a member's clinical picture.

Key Responsibilities:
  • Analyze members' clinical information and make assessments based on clinical presentation
  • Apply clinical guidelines and policies to evaluate medical necessity
  • Work with healthcare providers to promote quality member outcomes and optimize member benefits
  • Determine and assess abnormalities in complex clinical concepts and terms
  • Collaborate with case management nurses on discharge planning


Requirements:
  • a minimum of associate's degree in nursing
  • a minimum of 4 years care management or case management experience and requires a minimum of 2 years clinical, utilization review, or managed care experience; or any combination of education and experience, which would provide an equivalent background
  • Current active, valid and unrestricted RN license and/or certification to practice as a health professional within the scope of licensure in applicable state(s) or territory of the United States required


Salary: $46.11 per hour (estimated salary)

Benefits: We offer a comprehensive benefits package, including merit increases, paid holidays, Paid Time Off, and incentive bonus programs, medical, dental, vision, short and long term disability benefits, 401(k) +match, stock purchase plan, life insurance, wellness programs and financial education resources.

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