Remote Nurse Care Manager ll – RN (2:30pm – 11pm Eastern Time) – Compact License

Job Overview

  • Clinical License RN
  • State(s) Compact

Description

Nurse Care Manager ll (2:30pm – 11am Eastern Time) JR114007

Work Hours : 2pm – 11pm Eastern Time, Monday – Friday.

Location: Must reside within 50 miles / 1 hour commute of an Elevance Health Main Office / PulsePoint. Atlanta, Georgia area strongly preferred.

The Nurse Care Manager ll is responsible for collaborating with healthcare providers and members to drive personalized health management and improve health outcomes for optimal consumers. Performs assessments and care management activities telephonically 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.

Minimum Requirements:

  • 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, unrestricted RN license in the state of residence required.
  • Multi-state licensure will be required.

Preferred Qualifications:

  • AS or BS in nursing preferred.
  • Multi-state or Compact license, or additional individual state RN licenses a plus.
  • Clinical Experience in Med/Surg, Critical Care, ER, internal medicine a plus.
  • Call center or telephonic environment a plus.
  • Patient assessment and education preferred.
  • Certification as a Case Manager is 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.

 

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 Are

Elevance 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 Work

At 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.comfor assistance.

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