Atlanta, Georgia, United States · Hybrid
Anticipated End Date: 2026-07-01 Position Title: Medical Management Nurse Job Description: Location: This role enables associates to work virtually full-time, except for required in-person training sessions, providing ma…
Skills: Nursing Judgment, Critical Thinking, Holistic Assessment, Medical Necessity Review, Utilization Management
Indianapolis, Indiana, United States · Hybrid
Anticipated End Date: 2026-07-08 Position Title: Deputy Chief of Staff Job Description: Deputy Chief of Staff (IT Strategy & Planning Director) Location: Must be located or willing to relocate to Indianapolis, IN. This r…
Skills: IT Strategy, Strategic Planning, Governance, Financial Planning, Executive Communication
Indianapolis, Indiana, United States · Hybrid
$116k–$211k/yr
Anticipated End Date: 2026-07-24 Position Title: Patient Safety DRG Coding Auditor Principal Job Description: Location: This role enables associates to work virtually full-time, except for required in-person training ses…
Skills: DRG Coding Audit, ICD-10 Coding, Medical Record Review, Clinical Validation, Claims Auditing
Nashville, Tennessee, United States · Hybrid
Anticipated End Date: 2026-08-31 Position Title: LTSS Concierge Coordinator Job Description: LTSS Concierge Coordinator Candidate must reside within the state of Tennessee. Virtual: This role enables associates to work v…
Skills: Case Management, Person-Centered Planning, Care Coordination, Microsoft Excel, Microsoft Outlook
Los Angeles, California, United States · Hybrid
$80k–$151k/yr
Anticipated End Date: 2026-07-08 Position Title: Manager II Grievance/Appeals Job Description: Manager II Grievance/Appeals Location: Any Elevance Health PulsePoint. Hybrid 2: This role requires associates to be in-offic…
Skills: Grievance Management, Appeals Management, Regulatory Compliance, Healthcare Management, Audit Leadership
Miami, Florida, United States · Hybrid
Anticipated End Date: 2026-07-01 Position Title: Utilization Management Representative I Job Description: Utilization Management Representative I Location: This role enables associates to work virtually full-time, except…
Skills: Case Coordination, Precertification, Prior Authorization, Customer Service, Medical Terminology
Harvey, Louisiana, United States · Remote OK
Anticipated End Date: 2026-08-03 Position Title: Pharmacy Customer Associate – BioPlus Specialty Pharmacy Job Description: Pharmacy Customer Associate – BioPlus Specialty Pharmacy Location: LA-HARVEY, 2731 MANHATTAN BLVD…
Skills: Customer Relations, Claims Support, Membership Support, Research, Call Center Operations
Miami, Florida, United States · Remote OK
Anticipated End Date: 2026-06-29 Position Title: Grievance/Appeals Representative I Job Description: Grievance/Appeals Representative I Virtual: This role enables associates to work virtually full-time, with the exceptio…
Skills: Claims Processing, Investigation, Customer Service, Written Communication, Verbal Communication
Chesapeake, Virginia, United States · Hybrid
Anticipated End Date: 2026-08-31 Position Title: LTSS Service Coordinator-RN Clinician Job Description: LTSS Service Coordinator- RN Clinician The candidate should reside in the following locations Chesapeake Portsmouth,…
Skills: Case Management, Clinical Assessment, Care Planning, Member Coordination, Chronic Illness Management
Tampa, Florida, United States · Hybrid
Anticipated End Date: 2026-07-06 Position Title: Med Mgmt Nurse Job Description: Medical Management Nurse Hours: Monday - Friday 930am-6pm This role enables associates to work virtually full-time, with the exception of r…
Skills: Nursing Judgment, Critical Thinking, Holistic Assessment, Medical Necessity Review, Utilization Review
Atlanta, Georgia, United States · Hybrid
Anticipated End Date: 2026-07-13 Position Title: Health Educator Job Description: The Health Educator is responsible for responding to inbound and outbound inquiries/calls for Precision Care Advantage, Condition Care (tr…
Skills: Health Coaching, Disease Management, Patient Education, Behavior Change Techniques, Behavioral Assessment
Los Angeles, California, United States · Hybrid
$17/hr–$22/hr
Anticipated End Date: 2026-08-10 Position Title: Agency Service Rep II (US) Job Description: Agency Service Representative II Shift: M-F Location: Virtual -This role enables associates to work virtually full-time, except…
Skills: Customer Service, Communication, Problem Solving, Health Insurance Knowledge, Benefits Knowledge
Wallingford, Connecticut, United States · Hybrid
Anticipated End Date: 2026-07-08 Position Title: Strategic Sales Advisor Job Description: Strategic Sales Advisor Hybrid 1: This role requires associates to be in-office 1 - 2 days per week, fostering collaboration and c…
Skills: New Business Acquisition, Consultative Selling, Relationship Management, Business Planning, Client Education
Wallingford, Connecticut, United States · Hybrid
$81k–$139k/yr
Anticipated End Date: 2026-07-17 Position Title: PBM Pricing Strategy Analyst Senior Job Description: PBM Pricing Strategy Analyst Senior Location: This role requires associates to be in-office 1 - 2 days per week, foste…
Skills: Data Analysis, Pharmacy Benefits Manager, Excel, Analytical Skills, Medical Underwriting
Nashville, Tennessee, United States · Hybrid
Anticipated End Date: 2026-07-25 Position Title: Nurse Practitioner 100% Virtual, CareBridge Job Description: CareBridge Nurse Practitioner - Tennessee $5,000 Sign On Bonus *Seeking experienced Nurse Practitioner candida…
Skills: Primary Care, Urgent Health Care, Complex Care Management, Telehealth, Patient Education
Columbus, Georgia, United States · Hybrid
Anticipated End Date: 2026-06-29 Position Title: Outreach Care Specialist I (HEDIS) Job Description: Outreach Care Specialist I LOCATION: This is a virtual eligible role. You should be within a reasonable distance from o…
Skills: Care Coordination, Referral Management, Medical Record Auditing, HEDIS, Clinical Systems
Durham, North Carolina, United States · Hybrid
Anticipated End Date: 2026-07-12 Position Title: Peer Support Specialist-Foster Care (Union County, NC) Job Description: Peer Support Specialist-Foster Care Location: Union County North Carolina residency is required! Fi…
Skills: Outreach, Care Management, Case Coordination, Patient Advocacy, MS Office
Plano, Texas, United States · Hybrid
Anticipated End Date: 2026-07-01 Position Title: Operations Expert - Paragon Home Infusion Job Description: Operations Expert - Paragon Home Infusion Location: TX-PLANO, 3033 W PRESIDENT GEORGE BUSH HWY, STE 100 Hybrid: …
Skills: Technical Direction, Operational Training, Case Research, Workflow Management, Healthcare Benefit Referrals
Los Angeles, California, United States · Hybrid
$101k–$166k/yr
Anticipated End Date: 2026-07-04 Position Title: Project Manager Senior (US) Job Description: Project Manager Senior Hybrid: This role requires associates to be in-office 1 day per week, fostering collaboration and conne…
Skills: Project Planning, Strategic Prioritization, Risk Mitigation, Resource Management, Quality Management
West Des Moines, Iowa, United States · Hybrid
Anticipated End Date: 2026-07-02 Position Title: Credit & Collections Specialist Sr. Job Description: Credit & Collections Specialist Sr. LOCATION: This is a hybrid position requiring that you be in the office 1-2 days p…
Skills: Commercial Debt Collection, Medical Insurance Collection, Medicaid, Medicare, NextGen
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The Medical Management Nurse reviews complex clinical cases to determine medical necessity and provides expert consultation to Medical Directors. They collaborate with healthcare providers and case management nurses to optimize member outcomes and improve organizational policies.
Requires a minimum of an associate's degree in nursing and a valid, unrestricted RN license. Candidates must have at least 4 years of care or case management experience and 2 years of clinical, utilization review, or managed care experience.
Location: This role enables associates to work virtually full-time, except for required in-person training sessions, providing maximum flexibility and autonomy. This approach promotes productivity, supports work-life integration, and ensures essential face-to-face onboarding and skill development. Alternate locations may be considered if candidates reside within a commuting distance from an office.
Please note that per our policy on hybrid/virtual work, candidates not within a reasonable commuting distance from the posting location(s) will not be considered for employment, unless an accommodation is granted as required by law.
This position is not eligible for employment based sponsorship.
Work schedule: Monday - Friday 8:00am to 5:00pm EST/CST, with 2 rotating weekends Saturday/Sunday a year.
The Medical Management Nurse is responsible for review of the most complex or challenging cases that require nursing judgment, critical thinking, and holistic assessment of member’s clinical presentation to determine whether to approve requested service(s) as medically necessary. Works with healthcare providers to understand and assess a member’s clinical picture. Utilizes nursing judgment to determine whether treatment is medically necessary and provides consultation to Medical Director on cases that are unclear or do not satisfy relevant clinical criteria. Acts as a resource for Clinicians. May work on special projects and helps to craft, implement, and improve organizational policies.
How you will make an impact:
Minimum Requirements:
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.
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.
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.
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 and Influenza. 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 should submit the following form: Accessibility Accommodation Request Form and a member of the team will be in contact. Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state, and local laws, including, but not limited to, the Los Angeles County Fair Chance Ordinance and the California Fair Chance Act.
Prospective employees required to be screened under Florida law should review the education and awareness resources at HB531 | Florida Agency for Health Care Administration.
NOTE: Workday keeps job postings active through 11:59:59 PM on the day before the listed end date. Example: If the end date is 3/13, the posting will automatically come down on 3/12 at 11:59:59 PM. In other words — the job is posted until 3/13, not through 3/13.
Fueled by our bold purpose to improve the health of humanity, we are transforming from a traditional health benefits organization into a lifetime trusted health partner. Our nearly 100,000 associates serve more than 118 million people, at every stage of health. We address a full range of needs with an integrated whole health approach, powered by industry-leading capabilities and a digital platform for health. We believe that improving health for everyone is possible. It begins by redefining health, reimagining the health system, and strengthening our communities.
Offices: 220 Virginia Ave, Indianapolis, Indiana 46204, US
Fueled by our bold purpose to improve the health of humanity, we are transforming from a traditional health benefits organization into a lifetime trusted health partner. Our nearly 100,000 associates serve more than 118 million people, at every stage of health. We address a full range of needs with an integrated whole health approach, powered by industry-leading capabilities and a digital platform for health. We believe that improving health for everyone is possible. It begins by redefining health, reimagining the health system, and strengthening our communities.
Offices: 220 Virginia Ave, Indianapolis, Indiana 46204, US
