Remote Nurse Case Manager California HMO

Elevance Health; Costa Mesa (CA); Hybrid; USD 74,000 - 121,000; Full time

Benefits offered by this job

Comprehensive benefits package

401(k) + match

Equity stock purchase program

Incentive programs

Job summary

Elevance Health is seeking a Nurse Case Manager I (California HMO) to perform telephonic care management for members with complex needs. The role supports an integrated care plan across providers, groups, and community resources.

Candidates should have an RN license in California and a health-related BA/BS with clinical experience. The position offers hybrid/virtual work, with in-person onboarding and some required trainings.

Qualifications

• Requires BA/BS in a health related field and minimum of 3 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.

Responsibilities

• 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.
• Implements care plan by 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 Physician Advisors on the development of care management treatment plans.
• Assists in problem solving with providers, claims or service issues.

Skills

RN license CA

Case management

Discharge planning

Healthcare knowledge

Education

BA/BS in health-related field

Job description

Elevance Health is seeking a Nurse Case Manager I (California HMO) to perform telephonic care management for members with complex needs. The role supports an integrated care plan across providers, groups, and community resources.

Candidates should have an RN license in California and a health-related BA/BS with clinical experience. The position offers hybrid/virtual work, with in-person onboarding and some required trainings.