Nurse Case Mgr II (RN)

The Elevance Health Companies, Inc.; Los Angeles (CA); A distancia; USD 79.000 - 131.000; Jornada completa

Ventajas ofrecidas por este puesto de trabajo

Comprehensive benefits

401(k) matching

Descripción de la vacante

Elevance Health is seeking a Nurse Case Mgr II (RN) for virtual work with in-person trainings as needed. The role focuses on care management for members with complex needs via telephonic engagement, coordinating care across the continuum, and collaborating with health professionals.

Hybrid/virtual work policy applies; some offices may require onsite presence within commuting distance. Minimum requirements include a BA/BS in a health-related field and a valid RN license, plus multi-state

Formación

• Requires BA/BS in a health related field and minimum of 5 years of clinical experience.
• Current, unrestricted RN license in applicable state(s) is required.
• Multi-state RN licensure is required for providing services in multiple states upon hire.
• Telephonic and/or virtual nursing experience.
• Managed Care experience.

Responsabilidades

• Ensures member access to services appropriate to their health needs.
• Conducts assessments to identify individual needs and a care management plan.
• Assists in facilitating authorizations/referrals within benefits structure.
• Coordinates internal and external resources to meet identified needs.
• Monitors and evaluates effectiveness of the care management plan.
• Interfaces with Medical Directors and other health professionals on care plans.

Conocimientos

RN license

Telephonic nursing

Case management

Microsoft Office

Educación

BA/BS in health-related field

CCM certification preferred

Herramientas

Microsoft Office

Descripción del empleo

Nurse Case Mgr II (RN)

Location: Virtual - This role enables associates to work virtually full-time, except for 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. Alternate locations may be considered if candidates reside within a commuting distance from an office. Please note that per our policy on hybrid/virtual work, candidates not within a reasonable commuting distance from the posting location(s) will not be considered for employment, unless an accommodation is granted as required by law.

Work Shift: Monday – Friday, 9:00 am to 5:30 pm (PST or MST) with 2 evening shifts every week from 11:30 am to 8:00 pm (PST or MST).

The Nurse Case Mgr II (RN) is responsible for care management within the scope of licensure for members with complex and chronic care needs. Care management is conducted through screening, assessing, stratifying risk, planning, implementing (care coordination), following up, transitioning (transitional care), communicating post transition, and evaluating members. Our care model is designed to optimize member health care across the care continuum. We provide meaningful interventions that drive improvements in clinical outcomes, productivity, and quality of life. This is an outbound calling program, 100% telephonic.

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.
• Assists in facilitating authorizations/referrals as appropriate within benefits structure or through extra-contractual 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 other health professionals on the development of care management treatment plans.
• 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) is required.
• Multi-state RN licensure is required for providing services in multiple states upon hire.

Preferred Skills, Capabilities and Experiences:

• Active California RN license is highly preferred.
• Minimum 2 years of direct Case Management experience.
• Certification as a Case Manager, CCM is preferred.
• Telephonic and/or virtual nursing experience.
• Managed Care experience.
• Minimum 2 years’ experience in acute care setting.
• Experience with (Microsoft Office suite) and/or ability to learn new computer programs/systems/software quickly.
• Ability to speak and type at the same time.

For candidates working in person or virtually in the below locations, the salary* range for this specific position is $79,464 to $130,548.

Location(s): California, Colorado, Nevada, Washington.

In addition to your salary, Elevance Health offers benefits such as a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements).

We offer a range of market-competitive 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.

Job Level: Non-Management Exempt. Workshift: 1st Shift (United States of America). Job Family: MED > Licensed Nurse.

Please 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’re 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.

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.

The health of our associates and communities is a top priority for Elevance Health. We require all new candidates in certain patient/member-facing roles to become vaccinated against COVID-19 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 should submit the following form: Accessibility Accommodation Request Form and a member of the team will be in contact.

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.

Prospective employees required to be screened under Florida law should review the education and awareness resources at HB531 | Florida Agency for Health Care Administration.

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 should submit the following form: Accessibility Accommodation Request Form and a member of the team will be in contact. 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. Prospective employees required to be screened under Florida law should review the education and awareness resources at HB531 | Florida Agency for Health Care Administration

Elevance Health is an Equal Opportunity Employer/Disability/Veterans.