Nurse Care Manager II - Incident Management Reporting, Ohio at Elevance Health

Columbus, Ohio, United States

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Not SpecifiedCompensation

Mid-level (3 to 4 years)Experience Level

Full TimeJob Type

UnknownVisa

HealthcareIndustries

Requirements

HS diploma or equivalent
Minimum of 3 years of acute care clinical experience, condition specific clinical experience, home health/discharge planning experience
Minimum of 1 year in a Nurse Care Mgr I role or equivalent experience (or any combination of education and experience providing equivalent background)
Current, valid active unrestricted RN license in Ohio (multi-state licensure required if providing services in multiple states)
For URAC accredited areas: Current and active RN license in applicable state(s) allowing independent assessment within scope of practice; 3 years full-time equivalent of direct clinical care experience to the consumer (5 years preferred or equivalent combination of education and experience)

Responsibilities

Report incidents in compliance with regulatory and contract requirements
Oversee care coordination and provider incident reporting, including conducting reporting, triaging, investigating, resolving, tracking, and trending to ensure comprehensive and prompt response protecting member safety and preventing harm
Coordinate with members, care coordinators, providers, and interdisciplinary care team to complete prevention planning and mitigate risks
Ensure medically appropriate, high quality, cost-effective care by assessing medical necessity of inpatient admissions, outpatient services, out-of-network services, and appropriateness of treatment setting and level of care
Partner with physician clinical reviewers and/or medical directors to interpret appropriateness of care, intervention planning, and general clinical guidance
Collaborate with providers to assess consumer needs for early identification and proactive planning for discharge
Conduct clinical assessment to develop goals addressing individual needs, develop a care plan, implement and coordinate the care plan
Monitor and evaluate effectiveness of the care management plan and modify as necessary
Assist with development of utilization/care management policies and procedures
Participate in or lead intradepartmental teams, projects, and initiatives

Skills

Key technologies and capabilities for this role

Incident ReportingCare CoordinationCare ManagementTriageInvestigationRisk MitigationMedical Necessity AssessmentRegulatory ComplianceInterdisciplinary CollaborationHealth Outcomes Management

Questions & Answers

Common questions about this position

Is this Nurse Care Manager II position remote?

This role enables associates to work virtually full-time, with the exception of required in-person training sessions, but candidates must be within a reasonable commuting distance from the Ohio posting location(s) unless an accommodation is granted.

What are the minimum qualifications for this role?

Requires a HS diploma or equivalent and a minimum of 3 years of acute care clinical experience, condition specific clinical experience, home health/discharge planning experience and a minimum of 1 year in a Nurse Care Mgr I role or equivalent experience; or any combination of education and experience, which would provide an equivalent background. Current, valid active unrestricted RN license in Ohio required. Multi-state licensure is required if providing services in multiple states.

What is the salary for this position?

This information is not specified in the job description.

What benefits are offered for this role?

This information is not specified in the job description.

What experience makes a strong candidate for this Nurse Care Manager II role?

Candidates with 3+ years of acute care clinical experience, home health/discharge planning, prior Nurse Care Manager I experience, and an active unrestricted RN license in Ohio stand out, especially those with multi-state licensure for broader service coverage.

Elevance Health

Integrated health services and digital platform

About Elevance Health

Elevance Health focuses on enhancing the health of individuals throughout their lives by evolving from a traditional health benefits organization into a comprehensive health partner. The company serves over 118 million people, providing support at every stage of health through an integrated approach that addresses a wide range of health needs. Their services are backed by advanced capabilities and a digital health platform that streamlines access to care. Unlike many competitors, Elevance Health emphasizes a holistic view of health, aiming to redefine health and improve community well-being. The ultimate goal is to make health improvements accessible to everyone.

Indianapolis, IndianaHeadquarters

1944Year Founded

$309.4MTotal Funding

IPOCompany Stage

Enterprise Software, Social Impact, HealthcareIndustries

10,001+Employees

Benefits

Medical, dental, & vision insurance

401(k) + match

Paid holidays

Paid Time Off

Incentive bonus programs

Stock purchase plan

Life insurance

Wellness Programs

Financial education resources

Adoption & Surrogacy Assistance

Dependent-care Flexible Spending Account (DCFSA)

Parental Leave

Parental Transition Week

Critical Caregiving Leave

Risks

Departure of CFO John Gallina may create a gap in financial leadership.

Lawsuit against CMS over MA Star Ratings could lead to financial penalties.

CareBridge integration may face operational challenges, disrupting service delivery.

Differentiation

Elevance Health integrates whole health approach with digital health platform for comprehensive care.

Acquisition of CareBridge enhances home health services within Carelon division.

Strategic partnership with Clayton, Dubilier & Rice aims to innovate primary care delivery.

Upsides

AI integration in home health services can reduce hospital readmissions and improve outcomes.

Predictive analytics support early disease detection, aligning with Elevance's whole health approach.

Telehealth expansion offers opportunities to reach more patients remotely.

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