Nurse Case Mgr II
Nurse Case Mgr II
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Job Description
Anticipated End Date:
Position Title:
Nurse Case Mgr IIJob Description:
Nurse Case Manager II
Location: Alternate locations may be considered. This position will work in a hybrid model (remote and office). The ideal candidate will live within 50 miles of one of our Elevance Health PulsePoint locations.
The Nurse Case Manager II will be responsible for care management within the scope of licensure for members with complex and chronic care needs by assessing developing implementing coordinating monitoring and evaluating care plans designed to optimize member health care across the care continuum. Performs duties telephonically or onsite such as at hospitals for discharge planning.
How you will make an impact:
Ensures member access to services appropriate to their health needs
Conducts assessments to identify individual needs and a specific care management plan to address objectives and goals as identified during assessment Implements care plan by facilitating authorizations/referrals as appropriate within benefits structure or through extracontractual arrangements
Coordinates internal and external resources to meet identified needs
Monitors and evaluates effectiveness of the care management plan and modifies as necessary Interfaces with Medical Directors and Physician Advisors on the development of care management treatment plans
Negotiates rates of reimbursement as applicable Assists in problem solving with providers claims or service issues Assists with development of utilization/care management policies and procedures
Minimum Requirements:
Requires BA/BS in a health related field and minimum of 5 years of clinical experience; or any combination of education and experience which would provide an equivalent background.
Current unrestricted RN license in applicable state(s) required.
Preferred Skills Capabilities and Experiences:
Multistate licensure is required if this individual is providing services in multiple states Certification as a Case Manager is strongly preferred.
For URAC accredited areas the following applies: Requires a BA/BS and minimum of 5 years of clinical care experience; or any combination of education and experience which would provide an equivalent background.
Current and active RN license required in applicable state(s) Multistate licensure is required if this individual is providing services in multiple states Certification as a Case Manager and a BS in a health or human services related field preferred.
Job Level:
NonManagement ExemptWorkshift:
1st Shift (United States of America)Job Family:
MED > Licensed NursePlease be advised that Elevance Health only accepts resumes for compensation from agencies that have a signed agreement with Elevance Health. Any unsolicited resumes including those submitted to hiring managers are deemed to be the property of Elevance Health.
Who We Are
Elevance Health is a health company dedicated to improving lives and communities and making healthcare simpler. We are a Fortune 25 company with a longstanding history in the healthcare industry looking for leaders at all levels of the organization who are passionate about making an impact on our members and the communities we serve.
How We Work
At Elevance Health we are creating a culture that is designed to advance our strategy but will also lead to personal and professional growth for our associates. Our values and behaviors are the root of our culture. They are how we achieve our strategy power our business outcomes and drive our shared success for our consumers our associates our communities and our business.
We offer a range of marketcompetitive total rewards that include merit increases paid holidays Paid Time Off and 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.
Elevance Health operates in a Hybrid Workforce Strategy. Unless specified as primarily virtual by the hiring manager associates are required to work at an Elevance Health location at least once per week and potentially several times per week. Specific requirements and expectations for time onsite will be discussed as part of the hiring process. Candidates must reside within 50 miles or 1hour commute each way of a relevant Elevance Health location.
The health of our associates and communities is a top priority for Elevance Health. We require all new candidates in certain patient/memberfacing roles to become vaccinated against COVID19 and Influenza. If you are not vaccinated your offer will be rescinded unless you provide an acceptable explanation. Elevance Health will also follow all relevant federal state and local laws.
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. Applicants who require accommodation to participate in the job application process may contact for assistance. Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal state and local laws including but not limited to the Los Angeles County Fair Chance Ordinance and the California Fair Chance Act.
Required Experience:
Manager
Employment Type
Full-Time
