Nurse Medical Management Senior
4 days ago
We are seeking a highly skilled and experienced Nurse Medical Management Senior to join our team at Elevance Health. As a key member of our medical management team, you will play a critical role in ensuring that our members receive high-quality, cost-effective care.
Key Responsibilities- Team Leadership: Lead a team of nursing staff in providing medical management services to our members.
- Clinical Expertise: Utilize your clinical expertise to assess the medical necessity of inpatient admissions, outpatient services, and other medical treatments.
- Collaboration: Work closely with healthcare providers, medical directors, and other stakeholders to ensure that our members receive the best possible care.
- Case Management: Conduct precertification, continued stay review, care coordination, and discharge planning to ensure that our members receive medically necessary, quality care in a cost-effective setting.
- Regulatory Compliance: Ensure that our medical management processes comply with applicable regulatory requirements and industry standards.
- Communication: Develop and maintain effective communication with our members, providers, and other stakeholders to ensure that our medical management services are delivered in a timely and efficient manner.
- Education: 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.
- Experience: A minimum of 3 years of acute care clinical experience or case management, utilization management, or managed care experience.
- Certifications: Certification in the American Association of Managed Care Nurses is preferred.
We offer a comprehensive benefits package, incentive and recognition programs, equity stock purchase, and 401(k) contribution. Our salary range for this position is $77,448 to $96,810, based on a number of legitimate, non-discriminatory factors set by the company.
We are 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.
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