Nurse Care Manager Senior

2 months ago


Richmond, Virginia, United States Elevance Health Full time
Job Summary

The Senior Nurse Care Manager is a key member of our clinical leadership team, responsible for driving personalized health management and improving health outcomes for our members. This role requires a strong clinical background, excellent communication skills, and the ability to collaborate with healthcare providers and consumers to develop effective care plans.

Key Responsibilities
  • Collaborate with healthcare providers and consumers to assess medical necessity and develop high-quality, cost-effective care plans.
  • Partner with physician clinical reviewers and medical directors to interpret appropriateness of care and provide clinical guidance.
  • Implement and coordinate care plans, monitoring and evaluating their effectiveness and making necessary modifications.
  • Serve as a resource and preceptor for lower-level nurses and new care management staff.
  • Assist in the development of care management policies, procedures, and new programs.
  • Participate in intradepartmental and cross-functional teams, projects, and initiatives to improve processes and outcomes.
Requirements
  • A minimum of 5 years of acute care clinical experience, with a strong background in case management, disease management, and home health/discharge planning.
  • A current, active, valid unrestricted RN license in the applicable state(s), with multi-state licensure required for services in multiple states.
  • AAS or BS in nursing, with certification as a Case Manager and/or certification in the American Association of Managed Care Nurses preferred.
  • Broad clinical knowledge base of disease processes, with prior managed care and case management experience.
  • Knowledge of medical management processes and ability to interpret and apply member contracts, member benefits, and managed care products.
What We Offer

Elevance Health offers a comprehensive benefits package, including a competitive salary, 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.

Work Environment

Elevance Health operates in a Hybrid Workforce Strategy, with associates required to work at an Elevance Health location at least once per week. Candidates must reside within 50 miles or 1-hour commute each way of a relevant Elevance Health location.



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