Nurse Case Manager – California HMO
Elevance Health
full-time
Posted on:
Location Type: Hybrid
Location: Woodland Hills • California • Colorado • United States
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Salary
💰 $67,200 - $115,920 per year
About the role
- performing care management within the scope of licensure for members with complex and chronic care needs
- 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
- 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
Requirements
- Requires BA/BS in a health related field
- minimum of 3 years of clinical experience
- Current, unrestricted RN license in the state of California required
- 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.
Benefits
- comprehensive benefits package
- incentive and recognition programs
- equity stock purchase
- 401k contribution
- paid holidays
- Paid Time Off
- short and long term disability benefits
- medical, dental, vision benefits
- wellness programs
- financial education resources
Applicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills & Tools
care managementcare plan developmentdischarge planningclinical assessmentauthorization facilitationchronic disease managementmonitoring and evaluationproblem solving
Soft Skills
coordinationcommunicationinterpersonal skills
Certifications
RN licenseBA/BS in health related field