Telephonic Nurse Case Mgr II CA (US)

Elevance Health; Cerritos (CA); Remote; USD 70,000 - 90,000; Full time

Job summary

A healthcare company is seeking a Telephonic Nurse Case Manager II to manage care for members with complex health needs. Responsibilities include conducting assessments, implementing care plans, and coordinating services. Candidates must have a BA/BS in a health-related field, an active RN license, and at least 5 years of clinical experience. Preferred skills include case management experience and critical thinking abilities. The role offers competitive benefits and incentives.

Benefits

Paid Time Off

401(k) + match

Incentive bonus programs

Wellness programs

Qualifications

• Requires BA/BS in a health related field and minimum of 5 years of clinical experience.
• Current, unrestricted RN license in applicable state(s) required.
• Multi-state licensure is required if providing services in multiple states.

Responsibilities

• Ensures member access to services appropriate to their health needs.
• Conducts assessments to identify individual needs and care management plans.
• Implements care plans by facilitating authorizations and referrals.

Skills

Clinical experience

Critical thinking

Communication skills

Ability to manage emails

Education

BA/BS in health related field

Tools

Microsoft Office

Job description

Position Title: Telephonic Nurse Case Mgr II CA (US)

Job Description:

The Telephonic Nurse Case Manager II is responsible for care management within the scope of licensure for members with complex and chronic care needs by assessing, developing, implementing, coordinating, monitoring, and evaluating care plans designed to optimize member health care across the care continuum. Performs duties telephonically.

How you will make an impact:

• 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.
• Negotiates rates of reimbursement, as applicable.
• Assists in problem solving with providers, claims or service issues.
• Assists with development of utilization/care management policies and procedures.

Minimum Requirements:

• Requires BA/BS in a health related field and minimum of 5 years of clinical experience; or any combination of education and experience, which would provide an equivalent background.
• Current, unrestricted RN license in applicable state(s) required.
• Multi-state licensure is required if this individual is providing services in multiple states.

Preferred Capabilities, Skills and Experiences:

• Case Management experience is preferred.
• Certification as a Case Manager is preferred.
• Minimum 2 years’ experience in acute care setting is preferred.
• Managed Care experience is preferred.
• Ability to talk and type at the same time is preferred.
• Demonstrate critical thinking skills when interacting with members is preferred.
• Experience with (Microsoft Office) and/or ability to learn new computer programs/systems/software quickly is preferred.
• Ability to manage, review and respond to emails/instant messages in a timely fashion is preferred.

What We Offer:

We offer a range of market-competitive total rewards that include merit increases, paid holidays, Paid Time Off, and incentive bonus programs, medical, dental, vision, short and long term disability benefits, 401(k) +match, stock purchase plan, life insurance, wellness programs and financial education resources.

Equal Employment Opportunity:

Elevance Health is an Equal Employment Opportunity employer, and all qualified applicants will receive consideration for employment without regard to age, citizenship status, color, creed, disability, ethnicity, genetic information, gender (including gender identity and gender expression), marital status, national origin, race, religion, sex, sexual orientation, veteran status or any other status or condition protected by applicable federal, state, or local laws.