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Elevance HealthCore Competencies
Role fitCore Competencies
Use this summary to align your resume positioning with the role.
Demonstrates expertise in nursing judgment, critical thinking, and holistic assessment to evaluate medical necessity and promote quality member outcomes. Proficient in collaborating with healthcare providers and case management teams to optimize care and resource utilization.
Highest-signal resume keywords
RN LicenseCare Management ExperienceClinical AssessmentUtilization Review ExperienceProcess Improvement
About the role
Key responsibilities & impact- Review the most complex or challenging cases requiring nursing judgment, critical thinking, and holistic assessment
- Determine whether requested services are medically necessary
- Work with healthcare providers to understand and assess members’ clinical presentations
- Provide consultation to the Medical Director on unclear or complex cases
- Serve as a resource for clinicians and lower-level nurses
- Analyze members’ clinical information and apply clinical guidelines and policies to evaluate medical necessity
- Promote quality member outcomes, optimize benefits, and support effective resource use
- Identify abnormalities and inappropriate type, level, or quality of care
- Recommend alternate types, places, or levels of appropriate care
- Collaborate with case management nurses on discharge planning
- Provide nursing consultation to Medical Directors and providers
- Participate in teams, projects, initiatives, and process improvement activities
- Educate members about plan benefits and physicians and assist with case management
- Enhance training and orientation materials
- Complete quality audits and assist with corrective action plans
- Support process improvement initiatives
- Train lower-level clinical staff
Requirements
What you’ll need- Minimum associate’s degree in nursing
- Minimum of 4 years care management or case management experience
- Minimum of 2 years clinical, utilization review, or managed care experience
- Equivalent combination of education and experience may be accepted
- Current active, valid and unrestricted RN license and/or certification to practice as a health professional within the scope of licensure in the home state or territory of the United States
- Multi-state licensure required if providing services in multiple states
- Must reside within a reasonable commuting distance from the posting location(s), unless an accommodation is granted as required by law
- Position is not eligible for employment-based sponsorship
Benefits
Comp & perks- merit increases
- paid holidays
- Paid Time Off
- incentive bonus programs
- medical benefits
- dental benefits
- vision benefits
- short-term disability benefits
- long-term disability benefits
- 401(k) + match
- stock purchase plan
- life insurance
- wellness programs
- financial education resources
- Virtual full-time work, except for required in-person training sessions
- Flexible work-life integration
- Vaccination support/requirements for certain patient/member-facing roles
ATS Keywords
✓ Tailor your resumeApplicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills
Clinical Guidelines ApplicationMedical Necessity EvaluationDischarge PlanningQuality AuditsTraining Development
Soft Skills
Critical ThinkingCollaborationConsultationEducationResourcefulness
Certifications & Qualifications
Active RN LicenseMulti-State Licensure
Industry Keywords
Managed CareCase ManagementHealthcare ProvidersQuality Member OutcomesClinical Information Analysis