Nurse Care Mgr II (contract)

Job ID: JP00045555

Anticipated Start Date: 06/02/2025

Please note this is the target date and is subject to change. Mindlance will send official notice ahead of a confirmed start date.

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.

Responsible for collaborating with healthcare providers and/or consumer to drive personalized health management and improve health outcomes for optimal consumers. Performs care management activities within the scope of licensure for members with complex and chronic care needs.

This is a telephonic nurse care manager position for the Health Guide program. We provide white glove service to members of two external BCBS Health Plans. The membership served includes employees and their covered family members that work for pharmaceutical companies as well as auto union retirees that have not aged into Medicare and their covered family members.

Primary duties may include, but are not limited to:

• Ensures medically appropriate, high quality, cost effective care through assessing the medical necessity of inpatient admissions, outpatient services, out of network services, and appropriateness of treatment setting and level of care.
• Partners with physician clinical reviewers and/or medical directors to interpret appropriateness of care, intervention planning, and general clinical guidance.
• Collaborates with providers to assess consumer needs for early identification of and proactive planning for discharge.
• Conducts clinical assessment to develop goals that address individual needs in order to develop a care plan; implements and coordinates a care plan.
• Monitors and evaluates effectiveness of the care management plan and modifies as necessary.
• Assists with development of utilization/care management policies and procedures.
• Participates in or leads intradepartmental teams, projects, and initiatives.

Requirements:

• AS or BS in nursing preferred.
• Participation in the American Association of Managed Care Nurses preferred.
• Prior managed care experience preferred.
• Knowledge of medical management process and ability to interpret and apply member contracts, member benefits, and managed care products strongly preferred.
• Current and active RN license required in applicable state(s) that allows for an independent assessment to be conducted within their scope of practice.
• Requires 3 years full-time equivalent of direct clinical care experience to the consumer, 5 years full-time equivalent of direct clinical care experience to the consumer preferred or any combination of education and experience, which would provide an equivalent background.
• Certification as a Case Manager or a BS in a health or human services related field, also preferred.
• Candidates must possess an active compact RN license with the ability to obtain additional licensure if needed.
• Candidates with compact licensure and additional state licensure are highly preferred (i.e. compact + NY, MI, or MA, etc).
• Candidates must be comfortable working in a fast-paced call center environment, utilizing dialer technology to structure their calls for the day, and with providing white glove service.
• They need to be tech savvy and to be able to talk and type.
• Prior experience providing telephonic Case Management services to commercially insured health plan members is preferred.

Job Type: Contract opportunity.

Additional Details:

• Remote, WFH opportunity.
• We are recruiting into various shifts to cover our business hours of 8am-11pm Eastern.
• Some examples of shifts are 11:30am-8pm, 2:30-11pm, a split shift of 8am-12pm and 4pm to 8pm, 10:30am-7pm, 10am-6:30 pm, 9:30am-5pm.

Elevance Health operates in a Hybrid Workforce Strategy. Unless specified as primarily virtual by the hiring manager, contractors 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.

About Mindlance:

Founded in 1999, Mindlance is a certified diversity business and has been on the Staffing Industry Analysts list of Fastest-Growing US Staffing Firms twelve times. As a top-performing partner to leading workforce programs, Mindlance is known for delivering consistently high-quality tech first talent solutions. Our strong processes help clients build agile and diverse workforces, while creating an ease of onboarding and service to our consultants.

Mindlance provides specialized staffing solutions across the Healthcare industry and associated skill domains. Headquartered in Union, NJ with presence in over 40 key locations across US, Canada and India, servicing 200+ global clients and 5000+ consultants. Our services include Direct Sourcing, Global EoR & AoR, Payroll, Returnship, and Recruit-Train-Deploy solutions. With over $400 million in annual revenue, our success is rooted in a mindful commitment to balance in work, from which our name is derived.

Mindlance is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, or protected veteran status and will not be discriminated against based on disability.

To learn more about how Mindlance collects and uses personal information as part of the recruiting process, view our Privacy Notice and CCPA Addendum. As part of the recruitment process, we may ask for you to disclose and provide us with various categories of personal information, including identifiers, professional information, commercial information, education information, and other related information. Mindlance will only use this information to complete the recruitment process.

This posting is not an offer of employment. All applicants applying for positions in the United States must be legally authorized to work in the United States. The submission of intentionally false or fraudulent information in response to this posting may render the applicant ineligible for the position. Any subsequent offer of employment will be considered employment at-will regardless of the anticipated assignment duration.