RN Care Manager II - Telephonic Case Management

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

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.