Nurse Case Manager ll - California HMO

Elevance Health • Woodland Hills, CA

10d • Remote

About The Position

Nurse Case Manager ll (California HMO) JR181388 Virtual: This role enables associates to work virtually full-time, with the exception of required in-person training sessions, providing maximum flexibility and autonomy. This approach promotes productivity, supports work-life integration, and ensures essential face-to-face onboarding and skill development. Alternate locations may be considered if candidates reside within a commuting distance to an office. Please note that per our policy on hybrid/virtual work, candidates not within a reasonable commuting distance from the posting locations will not be considered for employment, unless an accommodation is granted as required by law. Work Hours – Pacific Time : 8 hour shift within 8am – 6pm PST. Please Note : Associates in this job working from a California location are eligible for overtime pay based on California employment law. The Nurse Case Manager ll (California HMO) is responsible for performing 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 with medical groups, providers, community resources, and members for discharge planning.

Requirements

• Requires BA/BS in a health-related field and 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 the state of California required.

Nice To Haves

• 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.

Responsibilities

• 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 assessment.
• Implements care plan by facilitating authorizations/referrals as appropriate within benefits structure or through extra-contractual arrangements.
• Coordinates internal and external resources to meet identified needs.
• Monitors and evaluates effectiveness of the care management plan and modifies as necessary.
• Interfaces with Medical Directors and Physician Advisors on the development of care management treatment plans.
• Assists in problem solving with providers, claims or service issues.
• Assists with development of utilization/care management policies and procedures.

Benefits

• 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).
• merit increases, paid holidays, Paid Time Off, and incentive bonus programs (unless covered by a collective bargaining agreement), medical, dental, vision, short and long term disability benefits, 401(k) +match, stock purchase plan, life insurance, wellness programs and financial education resources, to name a few.

What This Job Offers

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