[Hiring] RN Nurse Case Manager II @Elevance Health

Role Description

The RN Nurse Case Manager II (California HMO) is responsible for performing 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.
• Performing duties telephonically with medical groups, providers, community resources, and members for discharge planning.
• Ensuring member access to services appropriate to their health needs.
• Conducting assessments to identify individual needs and a specific care management plan to address objectives and goals as identified during assessment.
• Implementing care plan by facilitating authorizations/referrals as appropriate within benefits structure or through extra-contractual arrangements.
• Coordinating internal and external resources to meet identified needs.
• Monitoring and evaluating effectiveness of the care management plan and modifying as necessary.
• Interface with Medical Directors and Physician Advisors on the development of care management treatment plans.
• Assisting in problem solving with providers, claims or service issues.
• Assisting with development of utilization/care management policies and procedures.

Qualifications

• 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 the state of California required.

Requirements

• Case Manager experience within hospital or managed care setting is preferred.
• Clinical experience working with individuals with various chronic diseases, illnesses and medical needs strongly preferred.
• Knowledge/experience with discharge planning preferred.
• Certification as a Case Manager is preferred.

Benefits

• Comprehensive benefits package.
• Incentive and recognition programs.
• Equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements).