Nurse Case Mgr II

2 weeks ago

Las Vegas, United States Elevance Health Full time

Telephonic Nurse Case Manager II

Sign-on Bonus: $2000.

At Federal Health Products and Services - FHPS , a proud member of the Elevance Health, Inc. family of companies, it’s a powerful combination, and the foundation upon which we’re creating greater access to care for our members, greater value for our customers, and greater health for our communities. Join us and together we will drive the future of health care.

Location: This is a virtual position, but you must reside within 50 miles of an Elevance Health Pulse Point.

Work Schedule: Monday - Friday 10 am - 6:30 pm EST.

The Telephonic Nurse Case Manager II is responsible for care management within the scope of licensure for members with complex and chronic care needs by assessing, developing, implementing, coordinating, monitoring, and evaluating care plans designed to optimize member health care across the care continuum. Performs duties telephonically or on-site such as at hospitals for discharge planning.

How you will make an Impact:

  • Ensures member access to services appropriate to their health needs.

  • Conducts assessments to identify individual needs and a specific care management plan to address objectives and goals as identified during the assessment.

  • Implements care plan by facilitating authorizations/referrals as appropriate within the benefits structure or through extra-contractual arrangements.

  • Coordinates internal and external resources to meet identified needs.

  • Monitors and evaluates the effectiveness of the care management plan and modifies it as necessary.

  • Interfaces with Medical Directors and Physician Advisors on the development of care management treatment plans.

  • Negotiates rates of reimbursement, as applicable.

  • Assists in problem-solving with providers, claims, or service issues.

  • Assists with the development of utilization/care management policies and procedures.

Minimum Requirements:

  • Requires BA/BS in a health-related field and a minimum of 5 years of 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:

  • Certification as a Case Manager is preferred.

  • BS in a health or human services-related field preferred.

  • Strong oral, written, and interpersonal communication skills, problem-solving skills, facilitation skills, and analytical skills.

  • Knowledge of the medical management process and the ability to interpret and apply member contracts, member benefits, and managed care products are strongly preferred.

  • Prior managed care experience is strongly preferred.

For candidates working in person or remotely in the below locations, the salary* range for this specific position is $72,080 to $129,744.

Locations:  California; Colorado; Hawaii; Nevada; New York; Washington State; Jersey City, NJ.

In addition to your salary, Elevance Health offers benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). The salary offered for this specific position is based on a number of legitimate, non-discriminatory factors set by the company.  The company is fully 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 .

  • The salary range is the range Elevance Health in good faith believes is the range of possible compensation for this role at the time of this posting. This range may be modified in the future and actual compensation may vary from posting based on geographic location, work experience, education and/or skill level. Even within the range, the actual compensation will vary depending on the above factors as well as market/business considerations. No amount is considered to be wages or compensation until such amount is earned, vested, and determinable under the terms and conditions of the applicable policies and plans. The amount and availability of any bonus, commission, benefits, or any other form of compensation and benefits that are allocable to a particular employee remains in the Company's sole discretion unless and until paid and may be modified at the Company’s sole discretion, consistent with the law.

  • Behavioral Health Care Manager II

    1 hour ago

    Las Vegas, United States Elevance Health Full time

    A proud member of the Elevance Health family of companies, Carelon Behavioral Health, formerly Beacon Health Options, offers superior clinical mental health and substance use disorder management, a comprehensive employee assistance program, work/life support, specialty programs for autism and depression, and insightful analytics to improve the delivery of...

  • Case Manager II

    4 weeks ago

    Las Vegas, United States Encompass Health Full time

    Job DescriptionJob DescriptionMore personalized patient careMore professional impactBE THE CONNECTION. In your role as case manager, you can be the connection between exceptional care and the positive effect it has on every patient during their stay with us. Make an impact in a more profound way with your clinical and management skills as a part of national...

  • LPN Case Manager

    7 days ago

    Las Vegas, United States Evergreen Healthcare Group Full time

    Case Manager LPN or RNFull TimeWe’re so happy that you’re considering a career with us!Evergreen Healthcare stands as an excellent choice for those seeking a fulfilling career. Comprising a network of 11 skilled nursing and post-acute care centers across California and Washington, we take pride in bringing smiles to our residents and offering their...

  • LPN Case Manager

    1 week ago

    Las Vegas, United States Evergreen Healthcare Group Full time

    Case Manager LPN or RNFull TimeWe’re so happy that you’re considering a career with us!Evergreen Healthcare stands as an excellent choice for those seeking a fulfilling career. Comprising a network of 11 skilled nursing and post-acute care centers across California and Washington, we take pride in bringing smiles to our residents and offering their...

  • Case Manager

    1 week ago

    Las Vegas, United States Astrana Health Full time

    Description Job Title: Case Manager, RN Department: Health Services - ICM About the Role: Astrana Health is looking for a RN Case Manager and we are willing to train a RN without case management experience! What You'll Do: Comply with Case Management Department's policies and procedures 95 - 100% compliance with Utilization Management health plan...

  • Case Manager

    2 days ago

    Las Vegas, United States Astrana Health Full time

    Description Job Title: Case Manager, RN Department: Health Services - ICM About the Role: Astrana Health is looking for a RN Case Manager and we are willing to train a RN without case management experience! What You'll Do: Comply with Case Management Department's policies and procedures 95 - 100% compliance with Utilization Management health plan...

  • Telephonic Nurse Case Manager

    4 weeks ago

    Las Vegas, Nevada, United States AmTrust Financial Services, Inc. Full time

    Overview: AmTrust Financial Services, a fast growing commercial insurance company, has a need for a Telephonic Medical Case Manager, RN.   PRIMARY PURPOSE: To provide comprehensive quality telephonic case management to proactively drive a medically appropriate return to work through engagement with the injured employee, provider and employer.  Our...

  • Victim/witness Advocate I/II

    6 days ago

    Las Vegas, United States Clark County (NV) Full time

    ABOUT THE POSITION The Clark County District Attorney's Office is seeking qualified candidates to apply for the Victim/Witness Advocate I/II position. This position provides criminal justice system, case status, restitution process and related information to victims and witnesses in a variety of criminal situations; monitors cases through the judicial...

  • Foster Program Case Manager

    2 weeks ago

    Las Vegas, United States Eagle Quest Full time

    DESCRIPTION Eagle Quest, an organization serving at-risk and/or disadvantaged youth and their families, is searching for a Foster Program Case Manager with social work experience, and the ability to work with a variety of people from diverse socio-economic backgrounds and temperaments. Case Managers are the primary contact for assigned foster clients and are...

  • LPN Case Manager

    1 week ago

    Las Vegas, NV, United States Evergreen Healthcare Group Full time

    Case Manager LPN or RN Full Time We’re so happy that you’re considering a career with us! Evergreen Healthcare stands as an excellent choice for those seeking a fulfilling career. Comprising a network of 11 skilled nursing and post-acute care centers across California and Washington, we take pride in bringing smiles to our residents and offering their...

  • Case Manager

    2 weeks ago

    Las Vegas, United States Molina Healthcare Full time

    RN CASE MANAGER: OB HIGH RISK PREGNANCIES We are hiring this position for CLARK COUNTY NEVADA. Excellent computer skills and attention to detail are very important to multi task between systems, talk with members on the phone, and enter accurate contact notes. This is a fast paced position and productivity is important . We need staff to TRAVEL in the...

  • RN Private Patient Case

    3 weeks ago

    Las Vegas, United States NurseCore Management Services LLC Full time

    R N Private Patient Position ( H O M E C A R E) Nurse Core is seeking an R N for a private patient case in Las Vegas, Nevada, to support an infant in their home. The family is Spanish speaking but this position does not require fluent Spanish. The shift is Monday through Friday, from 8 am - 4 pm O R from 9 am - 5 pm. Ventilator experience is preferred for...

  • Tier II Help Desk Analyst

    1 week ago

    Las Vegas, Nevada, United States SAIC Career Site Full time

    Description SAIC is seeking an experienced, motivated, career and customer-service oriented Help Desk Analyst to join our team to begin an exciting and challenging career with SAIC in Las Vegas, NV.Duties: The qualified applicant will provide Tier II help desk support to users unable to resolve tech issues that exceed Tier 1 level support.The candidate must...

  • Field Service Technician II

    4 weeks ago

    Las Vegas, United States Empire Technological Group Limited Full time

    Job DescriptionJob DescriptionDescription:Empire Technological Group DBA Aruze gaming Global is looking to add a Field Service Technician II to our team!Responsibilities:· Demonstrate an in-depth understanding of gaming equipment, including gaming machines, consoles, peripherals, and associated software. · Effectively troubleshoot, diagnose, and resolve...

  • Travel Nurse

    4 weeks ago

    Las Vegas, Nevada, United States Flexcare Medical Staffing Full time

    Flex Care Medical Staffing is seeking an experienced Case Manager Registered Nurse for an exciting Travel Nursing job in Las Vegas, NV.Licensing, certifications, and other requirements subject to change and can vary by state and facility.Flex Care is a nationwide leader in the staffing of travel nurses and clinicians.With access to thousands of facilities...

  • RN Private Patient Case

    4 weeks ago

    LAS VEGAS, United States NurseCore Management Services LLC Full time

    RN Private Patient Position (HOME CARE)NurseCore is seeking an RN for a private patient case in Las Vegas, Nevada, to support a quadriplegic adult patient in their home.  This unique opportunity offers a sign on bonus of $1,000.  The shift is for Monday from 7a-7p.  Ventilator experience is required for this position.  **SIGN ON BONUS AVAILABLE** More...

  • RN Private Patient Case

    4 weeks ago

    Las Vegas, United States NurseCore Management Services LLC Full time

    RN Private Patient Position (HOME CARE) NurseCore is seeking an RN for a private patient case in Las Vegas, Nevada, to support an infant in their home.  The family is Spanish speaking but this position does not require fluent Spanish.  The shift is Monday through Friday, from 8 am - 4 pm OR from 9 am - 5 pm.  Ventilator experience is preferred for this...

  • RN Private Patient Case

    1 month ago

    LAS VEGAS, United States NurseCore Management Services LLC Full time

    RN Private Patient Position (HOME CARE)NurseCore is seeking an RN for a private patient case in Las Vegas, Nevada, to support an infant in their home.  The family is Spanish speaking but this position does not require fluent Spanish.  The shift is Monday through Friday, from 8 am - 4 pm OR from 9 am - 5 pm.  Ventilator experience is preferred for this...

  • LPN Case Manager

    5 days ago

    Las Vegas, NV, United States Evergreen Healthcare Group Full time

    Case Manager LPN or RNFull TimeWe’re so happy that you’re considering a career with us!Evergreen Healthcare stands as an excellent choice for those seeking a fulfilling career. Comprising a network of 11 skilled nursing and post-acute care centers across California and Washington, we take pride in bringing smiles to our residents and offering their...

  • Class II Compliance Operations Support

    4 weeks ago

    Las Vegas, Nevada, United States Aristocrat Full time

    SummaryThe role will be responsible for supporting the development and deployment of enhancements to the various IT platforms the compliance organization uses to support the management of our compliance obligations, related to the delivery of product to customers. (Compliance support) This will include engagement with various business stakeholders within and...