RN Nurse Case Manager ll (California HMO)

Elevance Health•Walnut Creek, CA

5d•$83,248 - $136,224•Remote

About The Position

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. Primary duties may include, but are not limited to: 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.

Requirements

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.