Transplant Nurse II

🔥 1 minute ago

🐊 Florida, New York, +2 more states – Remote

🐊 Florida – Remote 🗽 New York – Remote 🏈 Ohio – Remote 🤠 Texas – Remote

💵 $75.7k - $119.2k / year

⏰ Full Time

🟡 Mid-level

🟠 Senior

🦅 H1B Visa Sponsor

This company has sponsored H1B visas in the past.

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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

• Provide case and/or medical management for members receiving transplant services • Assess individual needs and develop specific care management plans • Implement care plans by facilitating authorizations and referrals • Coordinate internal and external resources to meet identified needs • Monitor and evaluate care management plans and modify them as needed • Interface with Medical Directors and Physician Advisors on treatment plans • Assist with provider, claims, and service issue resolution • Assist with development of utilization/care management policies and procedures • Collaborate with healthcare providers and members to promote quality outcomes and effective resource use • Assess medical necessity of admissions, services, procedures, out-of-network services, and treatment settings • Conduct pre-certification, retrospective, out-of-network, and treatment-setting appropriateness reviews • Ensure access to medically necessary, quality, cost-effective healthcare • Consult with clinical reviewers and medical directors throughout the medical management process • Collaborate with providers on early identification and proactive discharge planning • Facilitate member care transitions and refer plans of care to clinical reviewers as required • Facilitate accreditation by applying accrediting and regulatory requirements and standards • Continue learning and take on increasing peer-role assignments in preparation for advancement to the senior level

🎯 Requirements

• AS in nursing and minimum of 3 years of clinical experience; or any combination of education and experience providing an equivalent background • Current unrestricted RN license in applicable state(s) required • BA/BS or higher in a health-related field or certification as a care manager preferred • Knowledge of medical management process and ability to interpret and apply member contracts, member benefits, and managed care products strongly preferred for medical management associates • Must be able to be licensed in multiple states in a timely basis • Knowledge of health insurance/benefits strongly preferred • Strong clinical acumen • Knowledge of oncology/hematology or stem cell and organ transplant preferred • Candidates must reside within a reasonable commuting distance from a posting location unless an accommodation is granted • Candidates in certain patient/member-facing roles must become vaccinated against COVID-19 and Influenza, unless an acceptable explanation is provided • Monday–Friday availability, 8:00am–4:30pm EST • Ability to work in applicable Eastern and Central time zone locations preferred

🏖️ Benefits

• Comprehensive benefits package • 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 • Required in-person training sessions for virtual associates • Incentive and recognition programs • Equity stock purchase