Remote RN Care Manager - Chronic Care (Contract)

Elevance Health; Nevada (IA); Hybrid; USD 77,146,000 - 148,781,000; Part time

Job summary

Elevance Health seeks a skilled care management professional for a remote contract role. You will collaborate with providers to determine medical necessity, develop and adjust care plans, and support discharge planning for members with complex needs.

Eligible candidates must hold an active RN license in applicable states, have multi-state licensure, and show experience in acute care. Certification as a Case Manager is preferred; BS in health-related field also desirable.

Qualifications

• Requires HS diploma or equivalent and a minimum of 3 years of acute care clinical experience
• Current, active valid unrestricted RN license in applicable state(s) required
• Multi-state licensure is required if providing services in multiple states
• Certification as a Case Manager is preferred
• For URAC accredited areas: RN license allowing independent assessment within scope of practice
• Requires 3 years full-time equivalent direct clinical care experience; 5 years preferred or equivalent experience
• Certification as a Case Manager or BS in a health or human services related field preferred

Responsibilities

• Ensures medically appropriate, high quality, cost effective care through assessing the medical necessity of inpatient admissions and extensions of stay, 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 and implement a care plan
• Monitors and evaluates effectiveness of the care management plan and modifies as necessary

Skills

Care management

Education

RN license

BS in health or human services (preferred)

Case Manager Certification (preferred)

Job description

Elevance Health seeks a skilled care management professional for a remote contract role. You will collaborate with providers to determine medical necessity, develop and adjust care plans, and support discharge planning for members with complex needs.

Eligible candidates must hold an active RN license in applicable states, have multi-state licensure, and show experience in acute care. Certification as a Case Manager is preferred; BS in health-related field also desirable.