Nurse Medical Mgmt II

Elevance Health
Trenton, NJ Full Time
POSTED ON 1/11/2023 CLOSED ON 1/19/2023

What are the responsibilities and job description for the Nurse Medical Mgmt II position at Elevance Health?

**Nurse Medical Mgmt II**

Job Family: Medical and Clinical

Type: Full time

Date Posted:Jan 09, 2023

Req #: JR46314

**Location:**

National 50 Miles away from nearest PulsePoint, National 50 Miles away from nearest PulsePoint

GA, Atlanta

ME, South Portland

**Description**

**Responsible to collaborate with healthcare providers and members to promote quality member outcomes, to optimize member benefits, and to promote effective use of resources for more complex medical issues.**

Ensures medically appropriate, high quality, cost effective care through assessing the medical necessity of inpatient admissions, outpatient services, focused surgical and diagnostic procedures, out of network services, and appropriateness of treatment setting by utilizing the applicable medical policy and industry standards, accurately interpreting benefits and managed care products, and steering members to appropriate providers, programs or community resources. Works with medical directors in interpreting appropriateness of care and accurate claims payment. May also manage appeals for services denied.

**Primary duties may include, but are not limited to:**

Conducts precertification, continued stay review, care coordination, or discharge planning for appropriateness of treatment setting reviews to ensure compliance with applicable criteria, medical policy, and member eligibility, benefits, and contracts.

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 of and proactive planning for discharge planning

Facilitates member care transition through the healthcare continuum and refers treatment plans/plan of care to clinical reviewers as required and does not issue non-certifications.

Facilitates accreditation by knowing, understanding, correctly interpreting, and accurately applying accrediting and regulatory requirements and standards.

Serves as resource to lower-leveled nurses and may participate in or lead intradepartmental teams, projects and initiatives.

**Requirements:**

current active unrestricted RN license to practice as a health professional in applicable state(s) or territory of the United States.

Requires minimum of 3 years acute care clinical experience or case management, utilization management or managed care experience; or any combination of education and experience, which would provide an equivalent background.

Participation in the American Association of Managed Care Nurses preferred. Knowledge of medical management process and ability to interpret and apply member contracts, member benefits, and managed care products strongly preferred. Prior managed care experience strongly preferred.

**Associates in this role are expected to have strong oral, written and interpersonal communication skills, problem-solving skills, facilitation skills, and analytical skills.**

**For candidates working in person or remotely in the below locations, the salary* range for this specific position is $64,524 to $96,768**

Locations: California; Colorado; Nevada; Washington State; Jersey City, NJ; New York City, NY; Ithaca, NY and Westchester County, NY

In addition to your salary, Elevance Health offers benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). The salary offered for this specific position is based on a number of legitimate, non-discriminatory factors set by the company. The company is fully committed to ensuring equal pay opportunities for equal work regardless of gender, race, or any other category protected by federal, state, and local pay equity laws _._

* The salary range is the range Elevance Health in good faith believes is the range of possible compensation for this role at the time of this posting. This range may be modified in the future and actual compensation may vary from posting based on geographic location, work experience, education and/or skill level. Even within the range, the actual compensation will vary depending on the above factors as well as market/business considerations. No amount is considered to be wages or compensation until such amount is earned, vested, and determinable under the terms and conditions of the applicable policies and plans. The amount and availability of any bonus, commission, benefits, or any other form of compensation and benefits that are allocable to a particular employee remains in the Company's sole discretion unless and until paid and may be modified at the Company's sole discretion, consistent with the law.

Please be advised that Elevance Health only accepts resumes from agencies that have a signed agreement with Elevance Health. Accordingly, Elevance Health is not obligated to pay referral fees to any agency that is not a party to an agreement with Elevance Health. Thus, any unsolicited resumes, including those submitted to hiring managers, are deemed to be the property of Elevance Health.

**Be part of an Extraordinary Team**

Elevance Health is a health company dedicated to improving lives and communities - and making healthcare simpler. Previously known as Anthem, Inc., we have evolved into a company focused on whole health and updated our name to better reflect the direction the company is heading.

We are looking for leaders at all levels of the organization who are passionate about making an impact on our members and the communities we serve. You will thrive in a complex and collaborative environment where you take action and ownership to solve problems and lead change. Do you want to be part of a larger purpose and an evolving, high-performance culture that empowers you to make an impact?

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.

The health of our associates and communities is a top priority for Elevance Health. We require all new candidates to become vaccinated against COVID-19. If you are not vaccinated, your offer will be rescinded unless you provide - and Elevance Health approves - a valid religious or medical explanation as to why you are not able to get vaccinated that Elevance Health is able to reasonably accommodate. Elevance Health will also follow all relevant federal, state and local laws.

Elevance Health has been named as a Fortune Great Place To Work in 2021, is ranked as one of the 2021 World's Most Admired Companies among health insurers by Fortune magazine, and a Top 20 Fortune 500 Companies on Diversity and Inclusion. To learn more about our company and apply, please visit us at careers.ElevanceHealth.com. 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 may contact [ Email address blocked ] - Click here to apply to Nurse Medical Mgmt II for assistance.

EEO is the Law

Equal Opportunity Employer / Disability / Veteran

Please use the links below to review statements of protection from discrimination under Federal law for job applicants and employees.

EEO Policy Statement

EEO is the Law Poster

EEO Poster Supplement-English Version

Pay Transparency

Privacy Notice for California Residents

Elevance Health, Inc. is an E-verify Employer

Need Assistance?

Email us ([ Email address blocked ] - Click here to apply to Nurse Medical Mgmt II) or call
1-877-204-7664

Salary : $64,524 - $96,768

Registered Nurse (RN) - Days - Medical Unit-II - Telemetry
RWJBarnabas Health -
Hamilton, NJ
Technical Writer – II (Medical Device)
TekOne IT Services Pvt. Ltd. -
Princeton, NJ
Travel Nurse RN - Med/Surg - $2,360 per week in Trenton, NJ
Magnet Medical -
Trenton, NJ

For Employer
Looking for Real-time Job Posting Salary Data?
Keep a pulse on the job market with advanced job matching technology.
If your compensation planning software is too rigid to deploy winning incentive strategies, it’s time to find an adaptable solution. Compensation Planning
Enhance your organization's compensation strategy with salary data sets that HR and team managers can use to pay your staff right. Surveys & Data Sets

Sign up to receive alerts about other jobs with skills like those required for the Nurse Medical Mgmt II.

Click the checkbox next to the jobs that you are interested in.

  • Case Management Skill

    • Income Estimation: $84,376 - $110,118
    • Income Estimation: $88,056 - $111,055
  • Conformance Testing Skill

    • Income Estimation: $72,030 - $95,771
    • Income Estimation: $72,195 - $93,908
This job has expired.
View Core, Job Family, and Industry Job Skills and Competency Data for more than 15,000 Job Titles Skills Library

Job openings at Elevance Health

Elevance Health
Hired Organization Address Grand Forks, ND Part Time
Location: This position will be remote, based out of our Maine PulsePoint offices. An Actuarial Intern will be responsib...
Elevance Health
Hired Organization Address Smithfield, RI Full Time
Location: This position will work a hybrid model (1-2 days/week). The ideal candidate will live within 50 miles of one o...
Elevance Health
Hired Organization Address Newark, DE Part Time
Location: This position will be remote, based out of our Maine PulsePoint offices. An Actuarial Intern will be responsib...
Elevance Health
Hired Organization Address Dover, DE Part Time
Location: This position will be remote, based out of our Maine PulsePoint offices. An Actuarial Intern will be responsib...

Not the job you're looking for? Here are some other Nurse Medical Mgmt II jobs in the Trenton, NJ area that may be a better fit.

Care Mgmt Nurse - FT - HPW

Capital Health System, Inc., Pennington, NJ

Emergency Medical Technician

Advanced Nurse Transport Service, Warminster, PA