(RN) Nurse Medical Management II
Company: Elevance Health
Location: Sacramento
Posted on: January 23, 2023
Job Description:
(RN) Nurse Medical Management II
- Job Family: Medical and Clinical
- Type: Full time
- Date Posted:Jan 17, 2023
- Req #: JR12624Location:
- California, California
- California, San Francisco
- California, Chico
- California, San Diego
- California, Cerritos
- California, Los Angeles
- California, Camarillo
- California, Palo Alto
- California, Sacramento
- California, Brea
- California, Long Beach
- California, Bakersfield
- California, Apple Valley
- California, Costa MesaDescriptionThe Nurse Medical Management
II is responsible to collaborate with healthcare providers and
members to promote quality member outcomes, to optimize member
benefits, and to promote effective use of resources for more
complex medical issues.How you will make an impact:
- Ensures medically appropriate, high quality, cost effective
care through assessing the medical necessity of inpatient
admissions, outpatient services, focused surgical and diagnostic
procedures, out of network services, and appropriateness of
treatment setting by utilizing the applicable medical policy and
industry standards, accurately interpreting benefits and managed
care products, and steering members to appropriate providers,
programs or community resources.
- Works with medical directors in interpreting appropriateness of
care and accurate claims payment. May also manage appeals for
services denied.
- Conducts precertification, continued stay review, care
coordination, or discharge planning for appropriateness of
treatment setting reviews to ensure compliance with applicable
criteria, medical policy, and member eligibility, benefits, and
contracts.
- Consults with clinical reviewers and/or medical directors to
ensure medically appropriate, high quality, cost effective care
throughout the medical management process.
- Collaborates with providers to assess members needs for early
identification of and proactive planning for discharge
planning.
- Facilitates member care transition through the healthcare
continuum and refers treatment plans/plan of care to clinical
reviewers as required and does not issue non-certifications.
Facilitates accreditation by knowing, understanding, correctly
interpreting, and accurately applying accrediting and regulatory
requirements and standards. Serves as resource to lower-leveled
nurses and may participate in or lead intradepartmental teams,
projects and initiativesMinimum Requirements:
- Requires current active unrestricted RN license to practice as
a health professional in California.
- Requires minimum of 3 years acute care clinical experience or
case management, utilization management or managed care experience;
or any combination of education and experience, which would provide
an equivalent background.
- Some weekend shifts required.Preferred Skills, Capabilities and
Experiences:
- Participation in the American Association of Managed Care
Nurses preferred. Knowledge of medical management process and
ability to interpret and apply member contracts, member benefits,
and managed care products strongly preferred.
- Associates in this role are expected to have strong oral,
written and interpersonal communication skills, problem-solving
skills, facilitation skills, and analytical skills.For candidates
working in person or remotely in the below locations, the salary*
range for this specific position is $ 67,912 to $ 122,254Locations:
California; Colorado; Nevada; Washington State; Jersey City, NJ;
New York City, NY; Ithaca, NY and Westchester County, NYIn 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 Companys sole discretion,
consistent with the law.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, Sacramento , (RN) Nurse Medical Management II, Healthcare , Sacramento, California
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