Telephonic Nurse Case Manager II (CA) at Elevance Health

Woodland Hills, California, United States

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Not SpecifiedCompensation

Mid-level (3 to 4 years)Experience Level

Full TimeJob Type

UnknownVisa

HealthcareIndustries

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 applicable state(s); multi-state licensure required if providing services in multiple states
Must reside in California
Ability to work Monday - Friday 9:00am to 5:30pm PST with 1-2 late evenings 11:30am to 8:00pm PST

Responsibilities

Assesses, develops, implements, coordinates, monitors, and evaluates care plans designed to optimize member health care across the care continuum for members with complex and chronic care needs (telephonically)
Ensures member access to services appropriate to their health needs
Conducts assessments to identify individual needs and develops a specific care management plan to address objectives and goals
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
Negotiates rates of reimbursement, as applicable
Assists in problem solving with providers, claims or service issues
Assists with development of utilization/care management policies and procedures

Skills

Key technologies and capabilities for this role

NursingCase ManagementCare PlanningTelephonic AssessmentMulti-State LicensureCare CoordinationChronic Care ManagementUtilization Management

Questions & Answers

Common questions about this position

Is there a sign-on bonus for this position?

Yes, there is a $5000 sign-on bonus available.

What is the work arrangement and location requirement for this role?

The role is virtual full-time except for required in-person training sessions, and candidates must reside in California. Candidates not within a reasonable commuting distance from the posting location(s) will not be considered unless an accommodation is granted.

What are the minimum requirements for this position?

Requires BA/BS in a health related field and minimum of 5 years of clinical experience, or equivalent combination of education and experience. Current, unrestricted RN license in applicable state(s) required, and multi-state licensure if providing services in multiple states.

What are the preferred skills and experiences for this role?

Preferred qualifications include case management experience, certification as a Case Manager, minimum 2 years in acute care, managed care experience, ability to talk and type simultaneously, critical thinking skills, and proficiency with Microsoft Office or quick learning of new systems.

What are the working hours for this position?

Hours are Monday - Friday 9:00am to 5:30pm PST with 1-2 late evenings from 11:30am to 8:00pm PST.

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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