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Nurse Case Manager II
Location
United States
Posted
107 days ago
Salary
$79.5K - $136K / year
No structured requirement data.
Job Description
Nurse Case Manager II
Elevance Health
Anticipated End Date: 2026-04-06 Position Title: Nurse Case Manager II Job Description: Nurse Case Manager II-Licensed Nurse Location: Virtual: This role enables associates to work virtually full-time, except for required in-person training sessions, providing maximum flexibility and autonomy. This approach promotes productivity, supports work-life integration, and ensures essential face-to-face onboarding and skill development. Alternate locations may be considered if candidates reside within a commuting distance from an office. Please note that per our policy on hybrid/virtual work, candidates not within a reasonable commuting distance from the posting location(s) will not be considered for employment, unless accommodation is granted as required by law. The Nurse Case Manager II for Transplant is responsible for telephonic care management within the scope of licensure for transplant members with complex needs by assessing, developing, implementing, coordinating, monitoring, and evaluating care plans designed to optimize member health care across the care continuum. The clinician is responsible for ensuring appropriate, consistent administration of plan benefits by reviewing clinical information and assessing medical necessity under relevant guidelines and/or medical policies. 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. - Assists with development of utilization/care management policies and procedures. - Responsible for moderately complex cases that may require evaluation of multiple variables against guidelines when procedures are not clear. - Handles moderately complex benefit plans and/or contracts. - Works on reviews that may require guidance by more senior colleagues and/or management. - Serve as a resource to less experienced staff. - Conducts and may approve precertification, concurrent, retrospective, out-of-network, and/or appropriateness of treatment setting reviews by assessing clinical information against appropriate medical policies, clinical guidelines, and the relevant benefit plan/contract. - Process a medical necessity denial determination made by a Medical Director. - Work directly with healthcare providers to obtain and understand clinical information. - Refers complex or unclear reviews to higher level nurses and/or Medical Directors. - Educate members about plan benefits and physicians. Does not issue medical necessity non-certifications. Minimum Requirements: - Requires 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) required. - Multi-state licensure is required. Preferred Skills, Capabilities, Experiences: - Certification as a Case Manager is preferred. - Oncology/Hematology experience preferred. - Knowledge of MCG is preferred. - Being agile in a fast-paced environment preferred. - Strong computer and documentation skills; proficient in Microsoft 365 (Outlook, Teams) and electronic systems for care coordination, reporting, and record management; able to learn additional clinical/case management software is highly preferred. For candidates working in person or virtually in the below locations, the salary* range for this specific position is $79,464 to $136224 Locations: New York In addition to your salary, Elevance Health offers benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). The salary offered for this specific position is based on a number of legitimate, non-discriminatory factors set by the company. The company is fully committed to ensuring equal pay opportunities for equal work regardless of gender, race, or any other category protected by federal, state, and local pay equity laws. * The salary range is the range Elevance Health in good faith believes is the range of possible compensation for this role at the time of this posting. This range may be modified in the future and actual compensation may vary from posting based on geographic location, work experience, education, and/or skill level. Even within the range, the actual compensation will vary depending on the above factors as well as market/business considerations. No amount is considered to be wages or compensation until such amount is earned, vested, and determinable under the terms and conditions of the applicable policies and plans. The amount and availability of any bonus, commission, benefits, or any other form of compensation and benefits that are allocable to a particular employee remains in the Company's sole discretion unless and until paid and may be modified at the Company’s sole discretion, consistent with the law. Job Level: Non-Management Exempt Workshift: 1st Shift (United States of America) Job Family: MED > Licensed Nurse 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. 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 and Influenza. 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.com for assistance. Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state, and local laws, including, but not limited to, the Los Angeles County Fair Chance Ordinance and the California Fair Chance Act. Prospective employees required to be screened under Florida law should review the education and awareness resources at HB531 | Florida Agency for Health Care Administration.
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Specialty Care Nurse Practitioner - Cardiology (Heart Center)
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Specialty Care Nurse Practitioner - Cardiology (Heart Center)
Devoted HealthDevoted Health was founded in 2017 to provide seniors with healthcare plans and personalized health guides using world-class technology. On a mission to make he
Job Description A bit more about this role: This position represents an amazing opportunity for an experienced nurse practitioner (APRN) with a big heart and entrepreneurial spirit with extensive clinical experience offering care for cardiology patients. Your primary focus will be delivering world class virtual first cardiology care to our members in the Devoted Medical Heart Center. In this role you will be working in a next generation virtual heart clinic that dramatically expands access to care for America's most vulnerable seniors. The clinic focuses on providing highly accessible, high quality care for members with general cardiology conditions. As part of the clinic you will also provide dedicated clinical services during part of your clinical time to our heart failure clinic which is a highly tailored, specialty center focused on providing best in class heart failure management including optimizing guideline directed medical therapy, providing health coaching, and managing volume overload. You will be a key member of our interprofessional team. On a day-to-day basis you will work closely with heart failure RNs who are assigned as clinical guides for each patient in the heart failure clinic. You will also work closely with an interdisciplinary team including physicians, pharmacists, social workers and medical assistants. You will utilize and help improve our home-grown technology and electronic health information platform to carry out virtual visits. Responsibilities will include: - Conduct focused and thorough assessments of patients with general cardiology and heart failure needs through virtual consultations including ordering diagnostics as needed, interpreting labs and imaging data, and developing a treatment plan in collaboration with the specialty care clinic team. We expect that 80-90% of your time will be performing virtual visits. - Formulate accurate diagnoses and develop individualized treatment plans for patients with heart failure and general cardiology clinical conditions, including medication management, volume monitoring and management, and lifestyle modifications. - Initiate, titrate, and manage guideline-directed medical therapies (GDMT) for a diverse group of members with heart failure. - Provide proactive management of heart failure and comorbid conditions, and address potential barriers to optimal care to mitigate the risks of heart failure exacerbation and hospitalizations. - Assess and intervene in weight fluctuations and acute volume overload management of patients who are enrolled in the clinic. - Assess, diagnose, and manage the range of general cardiology conditions that are suitable for virtual care including stable coronary artery disease, hypertension, hyperlipidemia, stable atrial arrhythmias, peripheral arterial disease and chronic venous disease. 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Attributes to success: - You are experienced working on an interprofessional team and enjoy team-based care. - You have great clinical and non-clinical judgment. - You are thorough and take the time to address the needs of your patients. - You are deeply empathetic and humanistic, and want to go the last mile for your patients. - You enjoy a fast-paced, high-energy, organization. Agility and collaboration are key as we will change and improve quickly. - You welcome learning and using new technologies that are being developed in parallel. You thrive on knowing your work can help make these technologies better for you and your patients. - You learn from every experience and are not afraid to fail - that's how you're wired. - Finally and most importantly, you have a passion for making healthcare better, solving complex problems, and supporting the delivery of healthcare that we would want for our own family members. Desired skills and experience: - APRN with 5 or more years working in outpatient or inpatient cardiology clinical practice. - Experience performing visits over telehealth video platforms. - An understanding of managed care is a plus, including how to appropriately assess STARS/HEDIS measures, code clinical comorbidities, and identify clinical care gaps. - A strong desire to continue practicing clinical nursing and performing virtual visits - you believe in the mission of bringing care to where the patient lives. - Extra interest in bilingual Spanish or Haitian Creole speakers or strong cultural competencies across a range of cultures. - Multi-state licensure is required in addition to a willingness to obtain, and maintain additional licensure as requested. Licensure and Certification: - An active and clear RN and APRN license in the state of Illinois as well as APRN certification is required at time of hire and must be maintained while employed at Devoted Medical. - Cardiovascular Nurse Practitioner Certification is a plus. - Active BLS is required at time of hire and must be maintained while employed at Devoted Medical. Salary Range: $120K-155K base range plus performance based bonus paid out quarterly or annually ($10K-$20K) for a total comp range of $130K-170K Employer-sponsored health insurance and dental and vision plan with low or no premium #LI-REMOTE The pay range listed for this position is the range the organization reasonably and in good faith expects to pay for this position at the time of the posting. Once the interview process begins, your talent partner will provide additional information on the compensation for the role, along with additional information on our total rewards package. The actual base salary offered will depend on a variety of factors, including the qualifications of the individual applicant for the position, years of relevant experience, specific and unique skills, level of education attained, certifications or other professional licenses held, and the location in which the applicant lives and/or from which they will be performing the job. Our Total Rewards package includes: - Employer sponsored health, dental and vision plan with low or no premium - Generous paid time off - $100 monthly mobile or internet stipend - Stock options for all employees - Bonus eligibility for all roles excluding Director and above; Commission eligibility for Sales roles - Parental leave program - 401K program - And more.... *Our total rewards package is for full time employees only. Intern and Contract positions are not eligible. Healthcare equality is at the center of Devoted’s mission to treat our members like family. We are committed to a diverse and vibrant workforce. At Devoted Health, we’re on a mission to dramatically improve the health and well-being of older Americans by caring for every person like family. That’s why we’re gathering smart, diverse, and big-hearted people to create a new kind of all-in-one healthcare company — one that combines compassion, health insurance, clinical care, service, and technology - to deliver a complete and integrated healthcare solution that delivers high quality care that everyone would want for someone they love. Founded in 2017, we've grown fast and now serve members across the United States. And we've just started. So join us on this mission! Devoted is an equal opportunity employer. We are committed to a safe and supportive work environment in which all employees have the opportunity to participate and contribute to the success of the business. We value diversity and collaboration. Individuals are respected for their skills, experience, and unique perspectives. This commitment is embodied in Devoted’s Code of Conduct, our company values and the way we do business. As an Equal Opportunity Employer, the Company does not discriminate on the basis of race, color, religion, sex, pregnancy status, marital status, national origin, disability, age, sexual orientation, veteran status, genetic information, gender identity, gender expression, or any other factor prohibited by law. Our management team is dedicated to this policy with respect to recruitment, hiring, placement, promotion, transfer, training, compensation, benefits, employee activities and general treatment during employment.
Specialty Care Nurse Practitioner - Cardiology (Heart Center)
Devoted HealthDevoted Health was founded in 2017 to provide seniors with healthcare plans and personalized health guides using world-class technology. On a mission to make he
Job Description A bit more about this role: This position represents an amazing opportunity for an experienced nurse practitioner (APRN) with a big heart and entrepreneurial spirit with extensive clinical experience offering care for cardiology patients. Your primary focus will be delivering world class virtual first cardiology care to our members in the Devoted Medical Heart Center. In this role you will be working in a next generation virtual heart clinic that dramatically expands access to care for America's most vulnerable seniors. The clinic focuses on providing highly accessible, high quality care for members with general cardiology conditions. As part of the clinic you will also provide dedicated clinical services during part of your clinical time to our heart failure clinic which is a highly tailored, specialty center focused on providing best in class heart failure management including optimizing guideline directed medical therapy, providing health coaching, and managing volume overload. You will be a key member of our interprofessional team. On a day-to-day basis you will work closely with heart failure RNs who are assigned as clinical guides for each patient in the heart failure clinic. You will also work closely with an interdisciplinary team including physicians, pharmacists, social workers and medical assistants. You will utilize and help improve our home-grown technology and electronic health information platform to carry out virtual visits. Responsibilities will include: - Conduct focused and thorough assessments of patients with general cardiology and heart failure needs through virtual consultations including ordering diagnostics as needed, interpreting labs and imaging data, and developing a treatment plan in collaboration with the specialty care clinic team. We expect that 80-90% of your time will be performing virtual visits. - Formulate accurate diagnoses and develop individualized treatment plans for patients with heart failure and general cardiology clinical conditions, including medication management, volume monitoring and management, and lifestyle modifications. - Initiate, titrate, and manage guideline-directed medical therapies (GDMT) for a diverse group of members with heart failure. - Provide proactive management of heart failure and comorbid conditions, and address potential barriers to optimal care to mitigate the risks of heart failure exacerbation and hospitalizations. - Assess and intervene in weight fluctuations and acute volume overload management of patients who are enrolled in the clinic. - Assess, diagnose, and manage the range of general cardiology conditions that are suitable for virtual care including stable coronary artery disease, hypertension, hyperlipidemia, stable atrial arrhythmias, peripheral arterial disease and chronic venous disease. You will be ordering in-home diagnostics including echocardiograms, EKGs, and Holters and working with community cardiology practices for other diagnostics including stress testing and advanced cardiac imaging. - Collaborate closely with other members of the care team including PCPs, cardiologists and other Devoted team members including pharmacy, clinical nursing, social work, as well as interfacing with family members and caregivers to coordinate holistic care for the member, to ensure continuity of care and deliver a collaborative care plan. - Serve as the clinical advisor and provide clinical escalation support for the speciality clinic staff and other teams during business hours. - Utilize our home grown electronic health information system for visits while also providing feedback on how to improve the interface. - Maintain accurate and up-to-date patient medical records, ensuring compliance with relevant legal and ethical guidelines. - Participate in quality improvement initiatives and ongoing professional development to stay current on best practices and advancements in cardiovascular care. - Adhere to all relevant laws, regulations, and industry standards, including patient privacy and telehealth regulations. Attributes to success: - You are experienced working on an interprofessional team and enjoy team-based care. - You have great clinical and non-clinical judgment. - You are thorough and take the time to address the needs of your patients. - You are deeply empathetic and humanistic, and want to go the last mile for your patients. - You enjoy a fast-paced, high-energy, organization. Agility and collaboration are key as we will change and improve quickly. - You welcome learning and using new technologies that are being developed in parallel. You thrive on knowing your work can help make these technologies better for you and your patients. - You learn from every experience and are not afraid to fail - that's how you're wired. - Finally and most importantly, you have a passion for making healthcare better, solving complex problems, and supporting the delivery of healthcare that we would want for our own family members. Desired skills and experience: - APRN with 5 or more years working in outpatient or inpatient cardiology clinical practice. - Experience performing visits over telehealth video platforms. - An understanding of managed care is a plus, including how to appropriately assess STARS/HEDIS measures, code clinical comorbidities, and identify clinical care gaps. - A strong desire to continue practicing clinical nursing and performing virtual visits - you believe in the mission of bringing care to where the patient lives. - Extra interest in bilingual Spanish or Haitian Creole speakers or strong cultural competencies across a range of cultures. - Multi-state licensure is required in addition to a willingness to obtain, and maintain additional licensure as requested. Licensure and Certification: - An active and clear RN and APRN license in the state of Ohio as well as APRN certification is required at time of hire and must be maintained while employed at Devoted Medical. - Cardiovascular Nurse Practitioner Certification is a plus. - Active BLS is required at time of hire and must be maintained while employed at Devoted Medical. Salary Range: $120K-155K base range plus performance based bonus paid out quarterly or annually ($10K-$20K) for a total comp range of $130K-170K Employer-sponsored health insurance and dental and vision plan with low or no premium #LI-REMOTE The pay range listed for this position is the range the organization reasonably and in good faith expects to pay for this position at the time of the posting. Once the interview process begins, your talent partner will provide additional information on the compensation for the role, along with additional information on our total rewards package. The actual base salary offered will depend on a variety of factors, including the qualifications of the individual applicant for the position, years of relevant experience, specific and unique skills, level of education attained, certifications or other professional licenses held, and the location in which the applicant lives and/or from which they will be performing the job. Our Total Rewards package includes: - Employer sponsored health, dental and vision plan with low or no premium - Generous paid time off - $100 monthly mobile or internet stipend - Stock options for all employees - Bonus eligibility for all roles excluding Director and above; Commission eligibility for Sales roles - Parental leave program - 401K program - And more.... *Our total rewards package is for full time employees only. Intern and Contract positions are not eligible. Healthcare equality is at the center of Devoted’s mission to treat our members like family. We are committed to a diverse and vibrant workforce. At Devoted Health, we’re on a mission to dramatically improve the health and well-being of older Americans by caring for every person like family. That’s why we’re gathering smart, diverse, and big-hearted people to create a new kind of all-in-one healthcare company — one that combines compassion, health insurance, clinical care, service, and technology - to deliver a complete and integrated healthcare solution that delivers high quality care that everyone would want for someone they love. Founded in 2017, we've grown fast and now serve members across the United States. And we've just started. So join us on this mission! Devoted is an equal opportunity employer. We are committed to a safe and supportive work environment in which all employees have the opportunity to participate and contribute to the success of the business. We value diversity and collaboration. Individuals are respected for their skills, experience, and unique perspectives. This commitment is embodied in Devoted’s Code of Conduct, our company values and the way we do business. As an Equal Opportunity Employer, the Company does not discriminate on the basis of race, color, religion, sex, pregnancy status, marital status, national origin, disability, age, sexual orientation, veteran status, genetic information, gender identity, gender expression, or any other factor prohibited by law. Our management team is dedicated to this policy with respect to recruitment, hiring, placement, promotion, transfer, training, compensation, benefits, employee activities and general treatment during employment.

