Telephonic Nurse Case Manager II, California

Elevance Health; California; Vor Ort; USD 55.000 - 91.000; Vollzeit

Zusammenfassung

Elevance Health in Woodland Hills, CA is seeking a Telephonic Nurse Case Manager II to oversee care management for members with complex and chronic needs. This full-time role requires an RN license in California, 5 years of clinical experience, and CM certification preferred.

You will assess, develop care plans, coordinate authorizations, and collaborate with Medical Directors to optimize care. The position offers a Monday–Friday schedule (9:00am–5:30pm) with possible 1–2 late evenings and a

Qualifikationen

• BA/BS in a health-related field required.
• Minimum of 5 years of clinical experience required.
• Certification as a Case Manager preferred.

Aufgaben

• Ensure member access to services appropriate to their health needs.
• Conduct assessments to identify individual needs and develop care management plans.
• Implement care plans by facilitating authorizations/referrals as appropriate.
• Coordinate internal and external resources to meet identified needs.
• Monitor and evaluate the effectiveness of care management plans and modify as necessary.
• Interface with Medical Directors and Physician Advisors on treatment plans.
• Negotiate rates of reimbursement as applicable.
• Assist in problem-solving with providers, claims, or service issues.
• Assist with the development of utilization/care management policies and procedures.

Kenntnisse

Care coordination

Assessment

Care planning

Interdisciplinary collaboration

Ausbildung

BA/BS in health-related field

Jobbeschreibung

About This Role

The Telephonic Nurse Case Manager II is responsible for care management for members with complex and chronic care needs, providing assessments, developing care plans, and coordinating services to optimize member health care.

Highlights

• Pay: $40 - $66/hour
• Location: Woodland Hills, CA
• Schedule: Full-time, Monday - Friday 9:00am to 5:30pm with 1-2 late evenings

What You'll Do

• Ensure member access to services appropriate to their health needs.
• Conduct assessments to identify individual needs and develop care management plans.
• Implement care plans by facilitating authorizations/referrals as appropriate.
• Coordinate internal and external resources to meet identified needs.
• Monitor and evaluate the effectiveness of care management plans and modify as necessary.
• Interface with Medical Directors and Physician Advisors on treatment plans.
• Negotiate rates of reimbursement as applicable.
• Assist in problem-solving with providers, claims, or service issues.
• Assist with the development of utilization/care management policies and procedures.

Requirements

• Education:
  • BA/BS in a health-related field required
• Experience:
  • Minimum of 5 years of clinical experience required
  • Preferred: 2 years’ experience in an acute care setting
• Licenses & Certifications:
  • Current, unrestricted RN license in California required
  • Multi-state licensure required if providing services in multiple states
  • Certification as a Case Manager preferred

Benefits

• Comprehensive benefits package
• Incentive and recognition programs
• Equity stock purchase and 401k contribution

About Elevance Health

Elevance Health is a health company dedicated to improving lives and communities – and making healthcare simpler. They are a Fortune 25 company with a longstanding history in the healthcare industry, looking for leaders who are passionate about making an impact on their members and the communities they serve.