Job Family: Medical and Clinical
Type: Full time
Date Posted: Dec 11, 2023
Reference: JR95844
Description
RN / Nurse Case Manager l – Field Work (JR95844)
Location : This position requires field work in one of the following areas:
Austin, TX
Grand Prairie, TX
Outer counties of Houston, TX (Beaumont, Jefferson, Liberty, Warren, Orange County areas.)
Note: Remote when not in the field. This role requires face to face interactions approximately 3 – 4 days per week in the field – mileage reimbursed. (hospitals, clinics, members’ homes.)
The Nurse Case Manager l for Texas Medicaid is 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 and on-site such as at hospitals, clinics, and in homes, for discharge planning. Primary duties may include, but are not limited to:
Ensures member access to services appropriate to their health needs.
Identifies individual needs as they relate to the individual care management plan addressing objectives and goals, obtaining the appropriate equipment, have access to PCP’s, are prepared for follow up appointments, etc.
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:
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 the state of Texas required.
Preferred Qualifications:
Home Health and/or travel nursing experience.
Experience working with both pediatric and adult populations a plus.
Knowledge of Medicaid a plus.
Word and Excel proficiency.
Please be advised that Elevance Health only accepts resumes for compensation from agencies that have a signed agreement with Elevance Health. Any unsolicited resumes, including those submitted to hiring managers, are deemed to be the property of Elevance Health.
Who We Are
Elevance Health is a health company dedicated to improving lives and communities – and making healthcare simpler. We are a Fortune 25 company with a longstanding history in the healthcare industry, looking for leaders at all levels of the organization who are passionate about making an impact on our members and the communities we serve.
How We Work
At Elevance Health, we are creating a culture that is designed to advance our strategy but will also lead to personal and professional growth for our associates. Our values and behaviors are the root of our culture. They are how we achieve our strategy, power our business outcomes and drive our shared success - for our consumers, our associates, our communities and our business.
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.
Elevance Health operates in a Hybrid Workforce Strategy. Unless specified as primarily virtual by the hiring manager, associates are required to work at an Elevance Health location at least once per week, and potentially several times per week. Specific requirements and expectations for time onsite will be discussed as part of the hiring process. Candidates must reside within 50 miles or 1-hour commute each way of a relevant Elevance Health location.
The health of our associates and communities is a top priority for Elevance Health. We require all new candidates in certain patient/member-facing roles to become vaccinated against COVID-19. If you are not vaccinated, your offer will be rescinded unless you provide an acceptable explanation. Elevance Health will also follow all relevant federal, state and local laws.
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 elevancehealthjobssupport@elevancehealth.comfor assistance.