Nurse Case Manager II

2 weeks ago


Wilmington, North Carolina, United States Elevance Health Full time
Job Summary

We are seeking a skilled Nurse Case Manager II to join our team at Elevance Health. As a key member of our care management team, you will play a critical role in collaborating with healthcare providers and consumers to drive personalized health management and improve health outcomes.

Key Responsibilities
  • Collaborate with healthcare providers and consumers to develop and implement personalized care plans that address individual needs and goals.
  • Conduct clinical assessments to identify high-risk consumers and develop strategies to mitigate risks and improve health outcomes.
  • Partner with physician clinical reviewers and medical directors to interpret appropriateness of care, intervention planning, and general clinical guidance.
  • Develop and implement care management plans that ensure medically appropriate, high-quality, cost-effective care.
  • Monitor and evaluate the effectiveness of care management plans and modify as necessary.
  • Assist with the development of utilization/care management policies and procedures.
  • Participate in or lead intradepartmental teams, projects, and initiatives.
Requirements
  • 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.
  • 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.
What We Offer

Elevance Health offers a comprehensive benefits package, incentive and recognition programs, equity stock purchase, and 401(k) contribution. We are 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.



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