Nurse Case Manager II - California

Elevance Health; California; On-site; USD 58,000 - 90,000; Full time

Benefits offered by this job

Comprehensive benefits package

Equity stock purchase and 401k

Incentive and recognition programs

Job summary

Elevance Health in Woodland Hills, CA seeks a Nurse Case Manager II to oversee care management for members with complex and chronic health needs, developing, implementing, coordinating, monitoring, and evaluating care plans to optimize overall health outcomes. The role requires a BA/BS in a health-related field, 5+ years of clinical experience, and an active RN license (multi-state licensure preferred).

This full-time position features daytime hours with occasional evening shifts, and offers a

Qualifications

• BA/BS in a health-related field required.
• RN license current and unrestricted in applicable state.
• Multi-state licensure required if providing services in multiple states.
• Minimum of 5 years of clinical experience.
• Certification as a Case Manager preferred.

Responsibilities

• Assess individual needs and develop specific care management plans.
• Implement care plans by facilitating authorizations/referrals.
• Coordinate internal and external resources to meet identified needs.
• Monitor and evaluate the effectiveness of care management plans.
• Interface with Medical Directors and Physician Advisors on treatment plans.
• Negotiate rates of reimbursement as applicable.
• Assist in problem solving with providers, claims, or service issues.
• Assist with the development of utilization/care management policies and procedures.

Skills

Nurse Case Management

Care Coordination

Clinical Assessment

Interdisciplinary Collaboration

Education

BA/BS in a health-related field

Job description

About This Role

The Nurse Case Manager II will be responsible for care management for members with complex and chronic care needs, focusing on assessing, developing, implementing, coordinating, monitoring, and evaluating care plans to optimize member health care.

Highlights

• Pay: $41.84/hr to $65.50/hr
• Location: Woodland Hills, CA
• Schedule: Full-time, 9-5:30 Pacific time with 1-2 evening shifts per week

What You'll Do

• Assess individual needs and develop specific care management plans.
• Implement care plans by facilitating authorizations/referrals.
• Coordinate internal and external resources to meet identified needs.
• Monitor and evaluate the effectiveness of care management plans.
• Interface with Medical Directors and Physician Advisors on treatment plans.
• Negotiate rates of reimbursement as applicable.
• Assist in problem solving with providers, claims, or service issues.
• Assist with the development of utilization/care management policies and procedures.

Requirements

Education

• BA/BS in a health-related field required

Experience

• Minimum of 5 years of clinical experience required

Licenses & Certifications

• Current, unrestricted RN license in applicable state(s) required
• Multi-state licensure required if providing services in multiple states
• Certification as a Case Manager preferred

Benefits

• Comprehensive benefits package
• Incentive and recognition programs
• Equity stock purchase and 401k contribution

About Elevance Health

Elevance Health is a health company dedicated to improving lives and communities - and making healthcare simpler. They 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 their members and the communities they serve.