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Nurse Care Manager II Position
1 month ago
Job Summary:
Elevance Health is seeking a skilled Nurse Care Manager II to collaborate with healthcare providers and consumers to drive personalized health management and improve health outcomes for optimal consumers.
Key Responsibilities:
- 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:
- Requires a HS diploma
- Minimum of 3 years of acute care clinical experience, condition-specific clinical experience, home health/discharge planning experience
- 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 the state of California.
Preferred Qualifications:
- 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.
Benefits:
Elevance Health offers a comprehensive benefits package, incentive and recognition programs, equity stock purchase, and 401(k) contribution (all benefits are subject to eligibility requirements).
Location:
California
