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Senior Nurse Care Manager
2 months ago
We are seeking a highly skilled Senior Nurse Care Manager to join our team at Elevance Health. As a Senior Nurse Care Manager, you will play a critical role in collaborating with healthcare providers and consumers to drive personalized health management and improve health outcomes.
Key Responsibilities- Care Management: Ensure 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.
- Collaboration: Partner with physician clinical reviewers and/or medical directors to interpret appropriateness of care, intervention planning, and general clinical guidance.
- Discharge Planning: Collaborate with providers to assess consumer needs for early identification of and proactive planning for discharge.
- Care Planning: Implement and coordinate a care plan; monitor and evaluate effectiveness of the care management plan and modify as necessary.
- Leadership: Serve as a resource to lower-level nurses; function as a preceptor for new care management staff.
- Policy Development: Assist with development of care management policies, procedures, and new programs.
- Team Collaboration: Participate in or lead intradepartmental and cross-functional teams, projects, and initiatives, process improvement activities.
- A minimum of 5 years of acute care clinical experience, condition-specific clinical experience, home health/discharge planning experience, case management experience, disease management experience, and a minimum of 1 year in a Nurse Care Manager II role or equivalent experience.
- A current, active, valid unrestricted RN license in applicable state(s) required.
- Multi-state licensure is required if this individual is providing services in multiple states.
- An AS or BS in nursing is preferred.
- Certification as a Case Manager is preferred.
- Certification in the American Association of Managed Care Nurses is preferred.
- Broad clinical knowledge base of disease processes is strongly preferred.
- Prior managed care and case management experience is preferred.
- Knowledge of medical management process and ability to interpret and apply member contracts, member benefits, and managed care products is strongly preferred.
