RN Nurse Case Manager I (Medicaid) - Remote (Ohio)
Company: Elevance Health
Location: Cincinnati
Posted on: January 27, 2023
Job Description:
RN Nurse Case Manager I (Medicaid) - Remote (Ohio)
- Job Family: Medical and Clinical
- Type: Full time
- Date Posted:Dec 30, 2022
- Req #: JR26786Location:
- Ohio, Ohio
- Ohio, Columbus
- Ohio, CincinnatiDescriptionLocation: Remote but must reside in
Ohio state. This role will require up to 50% travel
(reimbursable)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 or
on-site such as at hospitals for discharge planning.How you will
make an impact:
- 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.
- Negotiates rates of reimbursement, as applicable. Assists in
problem solving with providers, claims or service issues.Minimum
Requirements:
- Requires BA/BS in a health-related field and minimum of 3 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)
required. Multi-state licensure is required if this individual is
providing services in multiple states.Preferred Skills,
Capabilities and Experience:
- Certification as a Case Manager is preferred
- Home care experience
- Case management experience
- Managed care
- Medicaid experienceFor URAC accredited areas the following
applies:
- Requires BA/BS and 3 years of clinical care experience; or any
combination of education and experience, which would provide an
equivalent background.
- Current and active RN license required in applicable state(s).
Multi-state licensure is required if this individual is providing
services in multiple states.
- Certification as a Case Manager and a BS in a health or human
services related field preferred.Please be advised that Elevance
Health only accepts resumes from agencies that have a signed
agreement with Elevance Health. Accordingly, Elevance Health is not
obligated to pay referral fees to any agency that is not a party to
an agreement with Elevance Health. Thus, any unsolicited resumes,
including those submitted to hiring managers, are deemed to be the
property of Elevance Health.Be part of an Extraordinary
TeamElevance Health is a health company dedicated to improving
lives and communities and making healthcare simpler. Previously
known as Anthem, Inc., we have evolved into a company focused on
whole health and updated our name to better reflect the direction
the company is heading.We are looking for leaders at all levels of
the organization who are passionate about making an impact on our
members and the communities we serve. You will thrive in a complex
and collaborative environment where you take action and ownership
to solve problems and lead change. Do you want to be part of a
larger purpose and an evolving, high-performance culture that
empowers you to make an impact?We offer a range of
market-competitive total rewards that include merit increases, paid
holidays, Paid Time Off, and incentive bonus programs (unless
covered by a collective bargaining agreement), medical, dental,
vision, short and long term disability benefits, 401(k) +match,
stock purchase plan, life insurance, wellness programs and
financial education resources, to name a few.The health of our
associates and communities is a top priority for Elevance Health.
We require all new candidates to become vaccinated against
COVID-19. If you are not vaccinated, your offer will be rescinded
unless you provide and Elevance Health approves a valid religious
or medical explanation as to why you are not able to get vaccinated
that Elevance Health is able to reasonably accommodate. Elevance
Health will also follow all relevant federal, state and local
laws.Elevance Health has been named as a Fortune Great Place To
Work in 2021, is ranked as one of the 2021 Worlds Most Admired
Companies among health insurers by Fortune magazine, and a Top 20
Fortune 500 Companies on Diversity and Inclusion. To learn more
about our company and apply, please visit us at
careers.ElevanceHealth.com. Elevance Health is an Equal Employment
Opportunity employer and all qualified applicants will receive
consideration for employment without regard to age, citizenship
status, color, creed, disability, ethnicity, genetic information,
gender (including gender identity and gender expression), marital
status, national origin, race, religion, sex, sexual orientation,
veteran status or any other status or condition protected by
applicable federal, state, or local laws. Applicants who require
accommodation to participate in the job application process may
contact ability@icareerhelp.com for assistance.EEO is the LawEqual
Opportunity Employer / Disability / VeteranPlease use the links
below to review statements of protection from discrimination under
Federal law for job applicants and employees.
- EEO Policy Statement
- EEO is the Law Poster
- EEO Poster Supplement-English Version
- Pay Transparency
- Privacy Notice for California ResidentsElevance Health, Inc. is
an E-verify EmployerNeed Assistance?Email us
(elevancehealth@icareerhelp.com) or call 1-877-204-7664
Keywords: Elevance Health, Cincinnati , RN Nurse Case Manager I (Medicaid) - Remote (Ohio), Healthcare , Cincinnati, Ohio
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