RN Transplant Case Manager II
2 weeks ago
We are seeking a highly skilled RN Transplant Case Manager II to join our team at Elevance Health. As a key member of our healthcare team, you will be responsible for providing case management and medical management services for members receiving transplant services.
Key Responsibilities- Conduct assessments to identify individual needs and develop a specific care management plan to address objectives and goals.
- Implement care plans by facilitating authorizations/referrals as appropriate within benefits structure or through extra-contractual arrangements.
- Coordinate internal and external resources to meet identified needs.
- Monitor and evaluate effectiveness of the care management plan and modify as needed.
- Interface with Medical Directors and Physician Advisors on the development of care management treatment plans.
- Assist in problem solving with providers, claims or service issues.
- Collaborate with healthcare providers and members to promote quality member outcomes, optimize member benefits, and promote effective use of resources for complex medical transplant issues.
- Ensure medically appropriate, high quality, cost effective care through assessing the medical necessity of inpatient admissions, outpatient services, focused surgical and diagnostic procedures, out of network services, and appropriateness of treatment setting.
- Conduct pre-certification, retrospective, out of network and appropriateness of treatment setting reviews to ensure compliance with applicable criteria, medical policy, and member eligibility, benefits, and contracts.
- Requires AS in nursing and minimum of 3 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.
- Previous transplant experience is highly preferred.
- Previous ICU, Med/Surg, and ER experience is extremely helpful for this position.
- Certification as a Case Manager is preferred.
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.
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.
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