Indiana Licensed Medical Management Nurse

Job Summary

Providing advanced clinical review and decision support, the contract Medical Management Nurse will evaluate complex cases, collaborate with healthcare providers, and guide care coordination while primarily working from home in Indiana.

Key Responsibilities

• Evaluate high complexity cases to determine medical necessity of requested services
• Collaborate with healthcare providers to promote quality outcomes and optimize benefit utilization
• Participate in policy development and support implementation of improved workflows across the organization

Required Qualifications

• Active, unrestricted RN license in applicable U.S. state(s); multi-state licensure required
• Associate's degree in Nursing (minimum)
• 4+ years of care management or case management experience
• 2+ years of clinical, utilization review, or managed care experience
• Proficiency with EMR systems