Nurse Care Manager II
2 weeks ago
We are seeking a skilled Nurse Case Manager II to join our team at Elevance Health. As a key member of our healthcare 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- Assess the medical necessity of inpatient admissions, outpatient services, and out-of-network services to ensure high-quality, cost-effective care.
- Partner with physician clinical reviewers and medical directors to interpret appropriateness of care, intervention planning, and general clinical guidance.
- Collaborate with providers to assess consumer needs for early identification of and proactive planning for discharge.
- Conduct clinical assessments to develop goals that address individual needs, implement and coordinate care plans, and monitor and evaluate their effectiveness.
- Assist with the development of utilization/care management policies and procedures.
- Participate in or lead intradepartmental teams, projects, and initiatives.
- 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 Manager I role or equivalent experience.
- A current, valid active unrestricted RN license in applicable state(s) required. Multi-state licensure is required if 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.
In addition to a competitive salary, 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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Nurse Care Manager II
2 weeks ago
Atlanta, Georgia, United States Elevance Health Full timeJob SummaryWe 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 ResponsibilitiesAssess the medical necessity of inpatient...
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