Nurse Care Manager II (2pm - 11am Eastern Time) - Military veterans preferred

Nurse Care Manager ll (2pm – 11am Eastern Time) JR113789 Work Hours

: 2pm – 11pm Eastern Time, Monday – Friday. Location:

Must reside within 50 miles / 1 hour commute of an Elevance Health Main Office / PulsePoint.

Atlanta, Georgia area preferred. The

Nurse Care Manager

ll is responsible for collaborating with healthcare providers and members to drive personalized health management and improve health outcomes for optimal consumers. Performs assessments and care management activities telephonically within the scope of licensure for members with complex and chronic care needs. Primary duties may include, but are not limited to: Ensures medically appropriate, high quality, cost effective care through assessing the medical necessity of inpatient admissions, outpatient services, out of network services, and appropriateness of treatment setting and level of care.

Partners with physician clinical reviewers and/or medical directors to interpret appropriateness of care, intervention planning, and general clinical guidance.

Collaborates with providers to assess consumer needs for early identification of and proactive planning for discharge.

Conducts clinical assessment to develop goals that address individual needs in order to develop a care plan; implements and coordinates a care plan.

Monitors and evaluates effectiveness of the care management plan and modifies as necessary.

Assists with development of utilization/care management policies and procedures.

Participates in or leads intradepartmental teams, projects, and initiatives.

Minimum Requirements: 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, unrestricted RN license in the state of residence required.

Multi-state licensure will be required.

Preferred Qualifications: AS or BS in nursing preferred.

Multi-state or Compact license, or additional individual state RN licenses a plus.

Clinical Experience in Med/Surg, Critical Care, ER, internal medicine a plus.

Call center or telephonic environment a plus.

Patient assessment and education preferred.

Certification as a Case Manager is preferred.

Prior managed care experience preferred.

Knowledge of medical management process and ability to interpret and apply member contracts, member benefits, and managed care products strongly preferred.

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