RN Medical Management Professional

3 weeks ago


Costa Mesa, California, United States Elevance Health Full time
{"Job Overview": "

Elevance Health is seeking a skilled RN Nurse Medical Management I to collaborate with healthcare providers and members to promote quality member outcomes, optimize member benefits, and promote effective use of resources.

"}, {"Responsibilities": "

  • Collaborate with healthcare providers and members to promote quality member outcomes, optimize member benefits, and promote effective use of resources.
  • Ensure medically appropriate, high quality, cost effective care through assessing the medical necessity of inpatient admissions, outpatient services, and appropriateness of treatment setting.
  • Consult with clinical reviewers and/or medical directors to ensure medically appropriate, high quality, cost effective care throughout the medical management process.
  • Facilitate member care transition through the healthcare continuum and refer treatment plans/plan of care to clinical reviewers as required.

"}, {"Requirements": "

  • Current active unrestricted RN license to practice as a health professional within the scope of practice from the state of California.
  • A minimum of 2 years acute care clinical experience is required.
  • Previous utilization review/utilization management experience in a managed care setting is preferred.

"}, {"What We Offer": "

  • Market-competitive total rewards, including merit increases, paid holidays, Paid Time Off, and incentive bonus programs.
  • A comprehensive benefits package, including medical, dental, vision, short and long term disability benefits, 401(k) +match, stock purchase plan, life insurance, wellness programs, and financial education resources.

"}, {"About Us": "

Elevance Health is a health company dedicated to improving lives and communities. 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.

"}



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