Nurse Case Mgr II (RN)

Elevance Health; California; On-site; USD 79,000 - 131,000; Full time

Job summary

Elevance Health in Woodland Hills, CA is seeking a Nurse Case Manager II (RN) to coordinate care for members with complex and chronic needs through a telephonic approach, ensuring access to appropriate services and developing care plans.

The role requires a BA/BS in a health-related field, at least five years of clinical experience, and an RN license. Multi-state licensure on hire and CCM are preferred. This is a full-time role with occasional evening shifts.

Qualifications

• BA/BS in a health-related field.
• Minimum of 5 years of clinical experience.
• Minimum 2 years of direct Case Management experience.
• Minimum 2 years’ experience in an acute care setting.
• Current, unrestricted RN license in applicable state(s).
• Multi-state RN licensure required upon hire.
• Certification as a Case Manager (CCM) preferred.

Responsibilities

• Ensure member access to services appropriate to their health needs
• Conduct assessments to identify individual needs and develop care management plans
• Facilitate authorizations/referrals as appropriate within benefits structure
• Coordinate internal and external resources to meet identified needs
• Monitor and evaluate the effectiveness of care management plans; interface with Medical Directors and other health professionals on treatment plans
• Assist in problem solving with providers, claims, or service issues
• Contribute to the development of utilization/care management policies and procedures

Skills

Care management

Assessment

Coordination

Communication

Education

BA/BS in health-related field

Job description

About This Role

The Nurse Case Manager II (RN) is responsible for care management for members with complex and chronic care needs, utilizing a telephonic approach to optimize member health care across the care continuum.

Highlights

• Pay: $79,464 - $130,548/year
• Location: Woodland Hills, CA
• Schedule: Full-time, Monday – Friday, 9:00 am to 5:30 pm with 2 evening shifts weekly

What You’ll Do

• Ensure member access to services appropriate to their health needs
• Conduct assessments to identify individual needs and develop care management plans
• Facilitate authorizations/referrals as appropriate within benefits structure
• Coordinate internal and external resources to meet identified needs
• Monitor and evaluate the effectiveness of care management plansInterface with Medical Directors and other health professionals on treatment plans
• Assist in problem solving with providers, claims, or service issues
• Contribute to 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
• Minimum 2 years of direct Case Management experience preferred
• Minimum 2 years’ experience in an acute care setting preferred

Licenses & Certifications

• Current, unrestricted RN license in applicable state(s) required
• Multi-state RN licensure required upon hire
• Certification as a Case Manager (CCM) 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 who are passionate about making an impact on their members and the communities they serve.