Nurse Case Manager II - California

Elevance Health • Woodland Hills, CA

4d • Remote

About The Position

The Nurse Case Manager II provides care management within the scope of licensure for members with complex and chronic care needs. The role assesses, develops, implements, coordinates, monitors, and evaluates care plans to optimize members’ health care across the care continuum. Duties are performed telephonically or on-site, such as at hospitals for discharge planning.

This is a California-based virtual role that supports full-time virtual work, except for required in-person training sessions. Applicants must live within a reasonable commuting distance of the posting location unless an accommodation is granted. The schedule is 9:00 a.m.–5:30 p.m. Pacific time, with one or two evening shifts (11:30 a.m.–8:00 p.m. Pacific time) per week; one late shift per month must be on Friday.

Requirements

• Bachelor’s degree in a health-related field and at least 5 years of clinical experience, or an equivalent combination of education and experience.
• Current, active, unrestricted RN license in applicable state(s).
• Multi-state licensure if providing services in multiple states.

Nice To Haves

• Case Manager certification.
• Bachelor’s degree in a health- or human-services-related field.

Responsibilities

• Ensure members have access to services appropriate to their health needs.
• Conduct assessments to identify individual needs and establish care management plans with objectives and goals.
• Implement care plans by facilitating authorizations and referrals within the benefits structure or through extra-contractual arrangements.
• Coordinate internal and external resources to meet identified needs.
• Monitor and evaluate the effectiveness of care management plans and modify them as necessary.
• Work with Medical Directors and Physician Advisors to develop care management treatment plans.
• Negotiate reimbursement rates, as applicable.
• Help resolve provider, claims, or service issues.
• Assist with developing utilization and care management policies and procedures.
• Perform care management duties telephonically or on-site, including hospital discharge planning.

Benefits

• Comprehensive benefits package, subject to eligibility requirements.
• Incentive and recognition programs.
• Equity stock purchase plan.
• 401(k) contributions.
• Merit increases.
• Paid holidays and paid time off.
• Incentive bonus programs, unless covered by a collective bargaining agreement.
• Medical, dental, and vision benefits.
• Short- and long-term disability benefits.
• 401(k) with match.
• Life insurance.
• Wellness programs.
• Financial education resources.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level