Nurse Care Manager I

2 weeks ago


Houston, United States Elevance Health Full time

Nurse Care Manager I Location: This position will work a hybrid model (remote and office). The Ideal candidate will live within 50 miles of one of our Elevance Health PulsePoint locations. Please Note: The hours for this position are 10am-7pm EST. Associates in this job are paid hourly and are eligible for overtime. The Nurse Care Manager I will be responsible for collaborating with healthcare providers and/or consumer to drive personalized health management and improve health outcomes for optimal consumers. Performs care management activities within the scope of licensure for members with complex and chronic care needs. How you will make an impact: Ensures medically appropriate, high quality, cost effective care through assessing the medical necessity of inpatient admissions and extensions of stay, outpatient services, out of network services, and appropriateness of treatment setting and level of care. Partners with physician clinical reviewers and/or medical directors to interpret appropriateness of care, intervention planning, and general clinical guidance. Collaborates with providers to assess consumer needs for early identification of and proactive planning for discharge. Conducts clinical assessment to develop goals that address individual needs in order to develop and implement a care plan. Monitors and evaluates effectiveness of the care management plan and modifies as necessary. Minimum Requirements: Requires minimum of 3 years of acute care clinical experience; or any combination of education and experience, which would provide an equivalent background. Current, unrestricted RN license in applicable state(s) required. Multi-state licensure is required if this individual is providing services in multiple states. Preferred Skills, Capabilities, and Experiences: Home health/discharge planning experience preferred. AS or BS in nursing preferred. Certification as a Case Manager is preferred. Certification as a Case Manager or a BS in a health or human services related field also preferred. Excellent oral and written communications preferred. Proficient computer skills preferred. Self-Motivated and agile preferred. Ability to multi-task and prioritize work preferred.



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