RN Nurse Case Manager II, California HMO

🔥 1 minute ago

🏄 California – Remote

🏄 California – Remote

💵 $83.2k - $136.2k / year

⏰ Full Time

🟡 Mid-level

🟠 Senior

👔 Manager

🦅 H1B Visa Sponsor

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👻 Ghost score 0%

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Elevance Health

WebsiteLinkedInAll Job Openings

10,000+ employees

🏥 Healthcare

⚕️ Healthcare Insurance

🤝 B2B

Healthcare • Healthcare Insurance • B2B

Elevance Health is transforming from a traditional health benefits organization into a lifetime trusted health partner, driven by a bold purpose to improve the health of humanity. With nearly 100,000 associates, they serve over 118 million people and utilize an integrated whole health approach supported by industry-leading capabilities and a digital health platform. Their mission includes redefining health, reimagining the health system, and strengthening communities.

📋 Description

• Perform care management within the scope of licensure for members with complex and chronic care needs • Assess, develop, implement, coordinate, monitor, and evaluate care plans across the care continuum • Perform telephonic duties with medical groups, providers, community resources, and members for discharge planning • Ensure member access to services appropriate to their health needs • Conduct assessments to identify individual needs and develop specific care management plans • Facilitate authorizations and referrals within the benefits structure or through extra-contractual arrangements • Coordinate internal and external resources to meet identified needs • Monitor and evaluate care plan effectiveness and modify plans as necessary • Interface with Medical Directors and Physician Advisors on care management treatment plans • Assist with problem solving involving providers, claims, or service issues • Assist with development of utilization and care management policies and procedures

🎯 Requirements

• BA/BS in a health-related field and minimum of 5 years of clinical experience; or any combination of education and experience providing an equivalent background • Current, unrestricted RN license in the state of California required • Case Manager experience within hospital or managed care setting is preferred • Clinical experience working with individuals with various chronic diseases, illnesses and medical needs strongly preferred • Knowledge/experience with discharge planning preferred • Certification as a Case Manager is preferred • Work within an 8-hour shift between 8am and 6pm Pacific Time • Candidates must reside within a reasonable commuting distance from the posting locations unless an accommodation is granted as required by law • New candidates in certain patient/member-facing roles must become vaccinated against COVID-19 and Influenza, unless they provide an acceptable explanation

🏖️ Benefits

• Comprehensive benefits package • Incentive and recognition programs • Equity stock purchase • 401k contribution • Merit increases • Paid holidays • Paid Time Off • Incentive bonus programs • Medical benefits • Dental benefits • Vision benefits • Short-term disability benefits • Long-term disability benefits • 401(k) with match • Stock purchase plan • Life insurance • Wellness programs • Financial education resources • Overtime pay for associates working from a California location, based on California employment law