Nurse Care Manager II/Sr - Temporary Role

Elevance Health; Atlanta (GA); Remote; USD 70,000 - 90,000; Full time

Job summary

Elevance Health is seeking a Nurse Care Manager II/Sr for a temporary virtual position. The nurse will collaborate with providers to improve health outcomes, manage care for individuals with complex needs, and ensure high-quality, cost-effective care. Qualified candidates will have extensive clinical experience, a valid RN license, and preferred case management certification.

Qualifications

• Minimum of 3 years of acute care clinical experience for Nurse Care Manager II.
• Minimum of 5 years of experience for Nurse Care Manager Sr.
• Current RN license in applicable state(s) required.

Responsibilities

• Collaborates with healthcare providers to manage health outcomes.
• Conducts clinical assessments to develop individualized care plans.
• Monitors and evaluates effectiveness of care management plans.

Skills

Clinical assessment

Care management

Collaboration

Medical management process knowledge

Education

HS diploma or equivalent

AS or BS in nursing preferred

Certification as a Case Manager preferred

Job description

Nurse Care Manager II/Sr - Temporary Role

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Nurse Care Manager II/Sr - Temporary Role

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Nurse Care Manager II/SrCarelon Health Guide**Please Note**: This is a short-term position expected to end on 12/31/2025 date.

Virtual

This role enables associates to work virtually full-time, with the exception of required in-person training sessions, providing maximum flexibility and autonomy. This approach promotes productivity, supports work-life integration, and ensures essential face-to-face onboarding and skill development.Level of position will be determined by relevant years of experience The Nurse Care Manager II/Nurse Care Manager Sr. is responsible for collaborating with healthcare providers and/or consumer to drive personalized health management and improve health outcomes for optimal consumers. Performs care management activities within the scope of licensure for members with complex and chronic care needs. How you will make an impact:Ensures medically appropriate, high quality, cost effective care through assessing the medical necessity of inpatient admissions, outpatient services, out of network services, and appropriateness of treatment setting and level of care. Partners with physician clinical reviewers and/or medical directors to interpret appropriateness of care, intervention planning, and general clinical guidance. Collaborates with providers to assess consumer needs for early identification of and proactive planning for discharge. Conducts clinical assessment to develop goals that address individual needs in order to develop a care plan; implements and coordinates a care plan. Monitors and evaluates effectiveness of the care management plan and modifies as necessary. Assists with development of utilization/care management policies and procedures. Participates in or leads intradepartmental teams, projects, and initiatives. Minimum Requirements -Nure Care Manager II: Requires a HS diploma or equivalent and a minimum of 3 years of acute care clinical experience, condition specific clinical experience, home health/discharge planning experience and a minimum of 1 year in a Nurse Care Mgr I role or equivalent experience; or any combination of education and experience, which would provide an equivalent background. Current, valid active unrestricted RN license in applicable state(s) required. Multi-state licensure is required if this individual is providing services in multiple states. AS or BS in nursing preferred. Certification as a Case Manager is preferred. Participation in the American Association of Managed Care Nurses preferred. Prior managed care experience preferred. Knowledge of medical management process and ability to interpret and apply member contracts, member benefits, and managed care products strongly preferred.

Minimum Requirements - Nurse Care Manager Sr.:Requires a HS diploma or equivalent and a minimum of 5 years of acute care clinical experience, condition specific clinical experience, home health/discharge planning experience, case management experience, disease management experience and minimum of 1 year in Nurse Care Mgr II role or equivalent experience; or any combination of education and experience, which would provide an equivalent background. Current, active valid unrestricted RN license in applicable state(s) required. Multi-state licensure is required if this individual is providing services in multiple states. AS or BS in nursing preferred. Certification as a Case Manager is preferred. Certification in the American Association of Managed Care Nurses preferred. Broad clinical knowledge base of disease processes strongly preferred. Prior managed care and case management experience preferred. Knowledge of medical management process and ability to interpret and apply member contracts, member benefits, and managed care products strongly preferred. For URAC accredited areas, the following applies: Current and active RN license required in applicable state(s) that allows for an independent assessment to be conducted within their scope of practice. Requires 3 years full-time equivalent of direct clinical care experience to the consumer, 5 years full-time equivalent of direct clinical care experience to the consumer preferred; or any combination of education and experience which would provide an equivalent background. Multi-state licensure is required if this individual is providing services in multiple states. Certification as a Case Manager or a BS in a health or human services related field also preferred

Seniority level

• Seniority level

  Mid-Senior level

Employment type

• Employment type

  Full-time

Job function

• Job function

  Health Care Provider

• Industries

  Hospitals and Health Care

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