Elevance Health

The Medical Management Clinician ensures appropriate and consistent administration of plan benefits by reviewing clinical information and assessing medical necessity against guidelines and policies. This role focuses on moderately complex case types that do not require the training or skill level of a registered nurse.

The Medical Management Nurse reviews the most complex cases requiring nursing judgment and holistic assessment to determine medical necessity for requested services, working with healthcare providers to understand the member's clinical picture. This role involves providing consultation to the Medical Director on unclear cases, acting as a resource for other Clinicians, and potentially working on special projects to craft and improve organizational policies.

The representative will serve as the initial contact between Care Management programs and identified members, handling inbound/outbound calls to provide program information and encourage participation. Responsibilities include gathering member data, explaining program value, directing inquiries to clinical staff, and initiating referrals for registered participants.

Nurse Case Manager I managing complex and chronic care needs

The Transitions of Care RN- Carebridge is responsible for participating in delivery of patient education and disease management interventions and for performing health coaching for members, across multiple lines, for health improvement/management programs for chronic diseases. Co...

The Outreach Care Specialist is responsible for ensuring that appropriate member treatment plans are followed on less complex cases and for proactively identifying ways to improve the health of our members and meet quality goals. Coordinates follow-up care plan needs for members ...

The Clinical Pharmacist (Prior Authorization) is responsible for managing the selection and utilization of pharmaceuticals and supports core clinical programs such as DUR, DIS, and formulary management. Researches and synthesizes detailed clinical data related to pharmaceuticals....

The Clinical Operations Medical Director is responsible for performing pre-authorizations and providing quality improvement solutions involving cardiovascular procedures and requests for oncologic treatment (medical or radiation) including future expansions. Determines the medica...

The Clinical Operations Medical Director is responsible for performing pre-authorizations and providing quality improvement solutions involving cardiovascular procedures and requests for oncologic treatment (medical or radiation) including future expansions. Determines the medica...

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 deve...