Elevance Health Work From Home Remote Jobs $25/Hour
Elevance Health Work From Home Remote Jobs $25/Hour, Responsible to collaborate with healthcare providers and members to promote quality member outcomes, optimize member benefits, and promote effective use of resources for the most complex or elevated 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.
|Post Name||Nurse Medical Mgmt Sr. (Remote)|
|Company Name||Elevance Health|
|Expected Salary||USD 20 USD 25 Per Hour|
|Address||Work From Home, United States|
Primary Duties for Elevance Health Careers:
- Continued stay review, care coordination, and discharge planning for appropriateness of treatment setting reviews to ensure compliance with applicable criteria, medical policy, and member eligibility, benefits, and contracts.
- 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.
- Ensures member access to medically necessary, quality healthcare in a cost-effective setting according to contract.
- Consult 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 members’ 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.
- Ensures consistency in benefit application.
- May lead cross-functional teams, projects, initiatives, and process improvement activities.
- May serve as departmental liaison to other areas of the business unit or as a representative on enterprise initiatives.
Requires Qualifications for Elevance Health Jobs in USA for Indian:
- Requires current active unrestricted RN license to practice as a health professional within the scope of practice in the state of California. Requires a minimum of 2 years of 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. Prior managed care experience required.
|Education Required||Bachelor of Science in Nursing|
|Schedule Type||Full Time|
|Work Hours||8 Hours|
Preferred Qualifications for Elevance Health Careers and Employment:
- Certification in the American Association of Managed Care Nurses is preferred.
- Knowledge of the medical management process and the ability to interpret and apply member contracts, member benefits, and managed care products are strongly preferred.
- Leadership skills are strongly preferred.
- Must have good typing skills, knowledge of how to use Microsoft Office programs, and general computer navigation familiarity.
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, 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 is a Top 20 Fortune 500 Companies on Diversity and Inclusion. To learn more about our company and apply, please visit us at careers.ElevanceHealthinc.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.