RN Transplant Case Manager II

4 weeks ago


Mason, 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. As a key member of our case management team, you will be responsible for providing comprehensive care management and medical management services to members receiving transplant services.

Key Responsibilities
  • Conduct thorough assessments to identify individual needs and develop personalized care plans to address objectives and goals.
  • Implement care plans by facilitating authorizations and referrals as needed, ensuring compliance with benefits and managed care products.
  • Coordinate internal and external resources to meet identified needs, promoting quality member outcomes and effective use of resources.
  • Monitor and evaluate the effectiveness of care management plans, making modifications as necessary.
  • 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 medical necessity, interpreting benefits and managed care products, and steering members to appropriate providers and resources.
Requirements
  • AS in nursing and a minimum of 3 years of clinical experience, or any combination of education and experience that provides an equivalent background.
  • Current unrestricted RN license in applicable state(s) required.
  • Ability to interpret and apply member contracts, member benefits, and managed care products.
  • Previous transplant experience is highly desirable, as is previous ICU, Med/Surg, and ER experience.
  • Certification as a Case Manager is preferred.
What We Offer

At Elevance Health, 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.

We operate in a Hybrid Workforce Strategy, with associates required to work at an Elevance Health location at least once 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 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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