About the position The Nurse Medical Management I position at Elevance Health is a remote role focused on collaborating with healthcare providers and members to enhance quality outcomes, optimize member benefits, and ensure effective resource utilization. The role involves conducting pre-certification, care coordination, and discharge planning to ensure compliance with medical policies and member eligibility. The nurse will facilitate care transitions and ensure members have access to necessary healthcare in a cost-effective manner. Responsibilities Conducts pre-certification, continued stay review, care coordination, or discharge planning for appropriateness of treatment setting reviews. , Ensures member access to medically necessary, quality healthcare in a cost-effective setting according to contract. , Consults 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 member's needs for early identification and proactive planning for discharge. , Facilitates member care transition through the healthcare continuum and refers treatment plans to clinical reviewers as required. , Facilitates accreditation by interpreting and applying accrediting and regulatory requirements and standards. Requirements Current active unrestricted RN license to practice as a health professional within the scope of practice from the state of residence. , A minimum of 2 years acute care clinical experience. Nice-to-haves Willingness to obtain a compact nursing license (at the company's expense) if not already held. , Previous NICU experience is very strongly preferred. , Knowledge of medical management process and ability to interpret and apply member contracts, member benefits, and managed care products strongly preferred. , Experience with the Medicaid population is preferred. , Leadership skills strongly preferred. , Strong oral, written, and interpersonal communication skills, problem-solving skills, facilitation skills, and analytical skills preferred. Benefits Merit increases , Paid holidays , Paid Time Off , Incentive bonus programs , Medical benefits , Dental benefits , Vision benefits , Short and long term disability benefits , 401(k) with matching , Stock purchase plan , Life insurance , Wellness programs , Financial education resources Apply Job!