Nurse Case Manager II
Company: Elevance Health
Location: Atlanta
Posted on: October 7, 2024
Job Description:
Location: This is a virtual position.Shift: Monday- Friday ,
Shifts vary between 8am-11pm EstResponsible for collaborating with
healthcare providers and/or consumer to drive personalized health
management and improve health outcomes for optimal consumers.
Performs care management activities within the scope of licensure
for members with complex and chronic care needs.Primary Duties May
Include, But Are Not Limited To
- Ensures medically appropriate, high quality, cost effective
care through assessing the medical necessity of inpatient
admissions, 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 a care plan; implements and
coordinates a care plan. Monitors and evaluates effectiveness of
the care management plan and modifies as necessary.
- Assists with development of utilization/care management
policies and procedures.
- Participates in or leads intradepartmental teams, projects, and
initiatives.Requirements
- a HS diploma or equivalent and a minimum of 3 years of acute
care clinical experience, condition specific clinical experience,
home health/discharge planning experience and a minimum of 1 year
in a Nurse Care Mgr I role or equivalent experience; or any
combination of education and experience, which would provide an
equivalent background.
- Current, valid active unrestricted RN license in applicable
state(s) required. Multi-state licensure is required if this
individual is providing services in multiple states.
- AS or BS in nursing preferred.
- Certification as a Case Manager is preferred. Participation in
the American Association of Managed Care Nurses preferred.
- Prior managed care experience preferred.
- Knowledge of medical management process and ability to
interpret and apply member contracts, member benefits, and managed
care products strongly preferred.For candidates working in person
or remotely in the below location(s), the salary* range for this
specific position is $35.50- $44.37Locations: MarylandIn addition
to your salary, Elevance Health offers benefits such as, a
comprehensive benefits package, incentive and recognition programs,
equity stock purchase and 401k contribution (all benefits are
subject to eligibility requirements). The salary offered for this
specific position is based on a number of legitimate,
non-discriminatory factors set by the Company. The Company is fully
committed to ensuring equal pay opportunities for equal work
regardless of gender, race, or any other category protected by
federal, state, and local pay equity laws.
- The salary range is the range Elevance Health in good faith
believes is the range of possible compensation for this role at the
time of this posting. This range may be modified in the future and
actual compensation may vary from posting based on geographic
location, work experience, education and/or skill level. Even
within the range, the actual compensation will vary depending on
the above factors as well as market/business considerations. No
amount is considered to be wages or compensation until such amount
is earned, vested, and determinable under the terms and conditions
of the applicable policies and plans. The amount and availability
of any bonus, commission, benefits, or any other form of
compensation and benefits that are allocable to a particular
employee remains in the Company's sole discretion unless and until
paid and may be modified at the Company's sole discretion,
consistent with the law.Please be advised that Elevance Health only
accepts resumes for compensation from agencies that have a signed
agreement with Elevance Health. Any unsolicited resumes, including
those submitted to hiring managers, are deemed to be the property
of Elevance Health.Who We AreElevance Health is a health company
dedicated to improving lives and communities - and making
healthcare simpler. We are a Fortune 25 company with a longstanding
history in the healthcare industry, looking for leaders at all
levels of the organization who are passionate about making an
impact on our members and the communities we serve.How We WorkAt
Elevance Health, we are creating a culture that is designed to
advance our strategy but will also lead to personal and
professional growth for our associates. Our values and behaviors
are the root of our culture. They are how we achieve our strategy,
power our business outcomes and drive our shared success - for our
consumers, our associates, our communities and our business.We
offer a range of market-competitive total rewards that include
merit increases, paid holidays, Paid Time Off, and incentive bonus
programs (unless covered by a collective bargaining agreement),
medical, dental, vision, short and long term disability benefits,
401(k) +match, stock purchase plan, life insurance, wellness
programs and financial education resources, to name a few.Elevance
Health operates in a Hybrid Workforce Strategy. Unless specified as
primarily virtual by the hiring manager, associates are required to
work at an Elevance Health location at least once per week, and
potentially several times per week. Specific requirements and
expectations for time onsite will be discussed as part of the
hiring process. Candidates must reside within 50 miles or 1-hour
commute each way of a relevant Elevance Health location.The health
of our associates and communities is a top priority for Elevance
Health. We require all new candidates in certain
patient/member-facing roles to become vaccinated against COVID-19.
If you are not vaccinated, your offer will be rescinded unless you
provide an acceptable explanation. Elevance Health will also follow
all relevant federal, state and local laws.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. Applicants
who require accommodation to participate in the job application
process may contact elevancehealthjobssupport@elevancehealth.com
for assistance.
Keywords: Elevance Health, Redan , Nurse Case Manager II, Executive , Atlanta, Georgia
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