Remote RN Case Manager, CA HMO

The Elevance Health Companies, Inc.; Cerritos (CA); On-site; USD 74,000 - 121,000; Full time

Job summary

The Elevance Health is seeking a Nurse Case Manager I for California HMO to coordinate member care and manage case plans. This role offers virtual full-time work with required in-person training and possible alternate locations near an office.

Responsibilities include accessing services, assessments, care plan implementation, coordinating resources, and collaborating with Medical Directors to optimize care. 3 years of clinical experience and RN license in CA required.

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 required.
• Case Manager experience within hospital or managed care setting preferred.
• Discharge planning knowledge preferred.

Responsibilities

• Ensures member access to services appropriate to their health needs.
• Conducts assessments to identify needs and creates a care management plan.
• Implements care plan with authorizations/referrals within benefits or through extra-contractual arrangements.
• Coordinates internal and external resources to meet identified needs.
• Monitors and evaluates effectiveness of the care plan and updates as needed.
• Interfaces with Medical Directors and Physician Advisors on care management plans.
• Assists in problem solving with providers, claims or service issues.

Skills

Nurse case management

Clinical assessment

Care coordination

Education

BA/BS in health-related field

RN license by CA

Job description

The Elevance Health is seeking a Nurse Case Manager I for California HMO to coordinate member care and manage case plans. This role offers virtual full-time work with required in-person training and possible alternate locations near an office.

Responsibilities include accessing services, assessments, care plan implementation, coordinating resources, and collaborating with Medical Directors to optimize care. 3 years of clinical experience and RN license in CA required.