Transplant Nurse II
Company: Elevance Health
Location: Chesapeake
Posted on: May 27, 2023
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Job Description:
Transplant Nurse II
Job Family: Medical and Clinical
Type: Full time
Date Posted:May 18, 2023
Req #: JR68515
Location:
IN, INDIANAPOLIS
Iowa, Iowa
Texas, Texas
Indiana, Indiana
Wisconsin, Wisconsin
Arizona, Arizona
Virginia, Virginia
Ohio, Ohio
Nebraska, Nebraska
Florida, Florida
Georgia, Georgia
Description
Hours: 11:30am - 8:00pm EST, Monday - Friday
How you will make an impact:
Responsible for providing case and/or medical management for
members receiving transplant services. Continue to learn and take
on increasing work assignments for the peer role on the team in
preparation for advancement to the senior level. Within the case
management role will within the scope of licensure assess, develop,
implement coordinate, monitor, and evaluate care plans designed to
optimize member health care across the care continuum and ensuring
member access to services appropriate to their specific health
needs.
Primary duties may include, but are not limited to:
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.
Interfaces with Medical Directors and Physician Advisors on the
development of care management treatment plans.
Assists in problem solving with providers, claims or service
issues.
Assists with development of utilization/care management policies
and procedures.
Within the medical management role will 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 transplant issues.
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.
Conducts pre-certification, retrospective, out of network and
appropriateness of treatment setting reviews to ensure compliance
with applicable criteria, medical policy, and member eligibility,
benefits, and contracts.
Ensures member access to medically necessary, quality healthcare in
a cost effective setting according to contract.
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.
Minimum Requirements:
Requires AS in nursing 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.
Preferred Skills, Capabilities and Experiences:
BA/BS or higher in a health related field or certification as a
care manager preferred.
Transplant experience is strongly preferred.
Experience with pre-certs, case management, and admissions is
preferred.
Knowledge of medical management process and ability to interpret
and apply member contracts, member benefits, and managed care
products strongly preferred for associates performing medical
management.
Must be able to be licensed in multiple states in a timely
basis.
Knowledge of health insurance/benefits strongly 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 Team
Elevance Health is a health company dedicated to improving lives
and communities - and making healthcare simpler. A Fortune 20
company with a longstanding history in the healthcare industry, 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 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 - 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
2022, has been ranked for five years running as one of the 2023
World's Most Admired Companies by Fortune magazine, and is a
growing Top 20 Fortune 500 Company. 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 Law
Equal Opportunity Employer / Disability / Veteran
Please use the links below to review statements of protection from
discrimination under Federal law for job applicants and
employees.
EEO Policy Statement
Know Your Rights
Pay Transparency
Privacy Notice for California Residents
Elevance Health, Inc. is anE-verify Employer
(https://www.e-verify.gov/sites/default/files/everify/posters/EVerifyParticipationPoster.pdf)
Need Assistance?
Email us (elevancehealth@icareerhelp.com) or call
1-877-204-7664
Keywords: Elevance Health, Chesapeake , Transplant Nurse II, Healthcare , Chesapeake, Virginia
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