RN Transplant Case Manager II

2 days ago


Grand Prairie, Texas, United States Elevance Health Full time
Job Summary

We are seeking a highly skilled RN Transplant Case Manager II to join our team at Elevance Health. This is a remote position, and you must be within 50 miles/1-hour commute of an eligible Elevance Health office location.

Key Responsibilities
  • Provide case management and/or medical management (UM/UR) for members receiving transplant services.
  • Assess, develop, implement, coordinate, monitor, and evaluate care plans designed to optimize member healthcare across the care continuum.
  • 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.
Requirements
  • 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.
What We Offer

We offer a range of market-competitive total rewards, including merit increases, paid holidays, Paid Time Off, and incentive bonus programs. We also offer medical, dental, vision, short and long-term disability benefits, 401(k) + match, stock purchase plan, life insurance, wellness programs, and financial education resources.

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.



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