SH-720 Medical Management Nurse.
Summary
Position Summary:
This role involves managing a case load with a focus on medical necessity reviews, clinical requests, and effective case management. If you have a keen eye for detail, excellent clinical judgment, and enjoy working in a dynamic, virtual environment, we’d love to hear from you.
Key Responsibilities
- Manage a census of 35-45 cases, aiming to address 25 cases per day. Responsibilities include medical necessity reviews, handling clinical requests, managing discharges, and making case management referrals.
- Participate in bi-weekly rounds with physicians and the case management team to coordinate patient care effectively.
Qualifications
- Candidate must have acute care, ICU, and Med/Surg experience in an inpatient hospital (bedside care) setting.
- Preferred experience in Utilization Management and/or familiarity with Milliman Care Guidelines.
- Required experience in acute inpatient (hospital) nursing, demonstrating strong clinical knowledge and decision-making skills.
- Comfortable working in a virtual setting with proficiency in IT/computer applications, including Excel, Microsoft Outlook, and Microsoft Teams.
- Quick learner with the ability to adapt to frequent process changes.
- Consistent and excellent attendance record.
- Valid Indiana RN license or compact license is essential.
- Must reside within 50 miles of an Elevance Health pulse point.
Syra Health is an equal opportunity employer and values diversity at all levels. Lived experience and non-traditional backgrounds are welcomed and encouraged.
