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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 case management, clinical guidelines application, and collaboration with healthcare providers to optimize resource use and ensure safe discharge planning.
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
- Apply clinical guidelines and policies to evaluate medical necessity
- Promote quality member outcomes, optimize member benefits, and support effective resource use
- Assess complex clinical concepts, symptoms, and aggregate member information
- Identify inappropriate type, level, or quality of care
- Provide consultation to the Medical Director on complex, unclear, or peculiar cases
- Recommend alternate types, places, or levels of appropriate care
- Collaborate with case management nurses on discharge planning
- Ensure members have appropriate equipment, environment, and education for safe discharge
- Serve as a resource to lower-level nurses and clinicians
- Participate in intradepartmental and cross-functional teams, projects, initiatives, and process improvement activities
- Educate members about plan benefits and physicians and assist with case management
- Enhance training and orientation materials with leadership
- Complete quality audits and assist with corrective action plans
- Assist with process improvement initiatives
- Train lower-level clinician 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
- Any combination of education and experience providing an equivalent background may qualify
- Current active, valid and unrestricted RN license and/or certification to practice as a health professional within the scope of licensure in applicable state(s) or territory of the United States
- Multi-state licensure required if providing services in multiple states
- Availability Monday–Friday, 8am–5pm MST, with some holidays and weekends depending on business needs
- Candidates must reside within a reasonable commuting distance from the posting location(s), unless accommodation is granted as required by law
- New candidates in certain patient/member-facing roles must become vaccinated against COVID-19 and Influenza, unless an acceptable explanation is provided
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 and autonomy
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 ApplicationHolistic AssessmentMedical Necessity EvaluationDischarge PlanningQuality Audits
Soft Skills
Critical ThinkingCollaborationConsultationEducationLeadership
Certifications & Qualifications
Active RN LicenseMulti-State Licensure
Industry Keywords
Case ManagementManaged CareHealthcare ProvidersMember OutcomesResource Optimization