The Transplant Nurse II provides case and medical management for members receiving transplant services, focusing on optimizing healthcare outcomes and resource use. Responsibilities include conducting assessments, developing care plans, and performing medical necessity reviews for inpatient and outpatient services.
Elevance Health
39 Remote Job Openings at Elevance Health
Perform telephonic care management for members with complex and chronic needs by assessing, implementing, and monitoring care plans. Coordinate internal and external resources and interface with Medical Directors to optimize member healthcare outcomes.
Responsible for performing care management for members with complex and chronic needs by assessing and implementing optimized care plans. Duties include coordinating internal and external resources and interfacing with Medical Directors to ensure appropriate member access to services.
Responsible for managing care for members with complex and chronic needs by assessing, implementing, and monitoring personalized care plans. Coordinates internal and external resources and interfaces with Medical Directors to optimize member health outcomes.
Collaborate with healthcare providers and consumers to drive personalized health management and improve outcomes for members with complex needs. Assess medical necessity for admissions and services while developing and monitoring individualized care plans.
Manager Nurse Practitioners 100% Virtual, CareBridge
Elevance Health
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Full Time
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6 hours ago
Elevance Health
Oversees clinical program operations and manages a team of Nurse Practitioners to ensure efficient patient treatment. Responsibilities include managing caseloads, performing physical exams, and evaluating the performance of direct reports.
Nurse Practitioner, Bilingual (100% Virtual) - CareBridge
Elevance Health
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Full Time
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6 hours ago
Elevance Health
Collaborate with physicians and families to develop and implement complex clinical plans of care for adult patients with chronic conditions. Provide primary and urgent healthcare via telephone and video modalities while coordinating resources and maintaining medical records.
Collaborate with physicians and families to develop and implement complex clinical care plans for adult patients with chronic conditions. Provide primary and urgent healthcare via telephone and video modalities for Medicaid and dual-eligible members.
Behavioral Health Case Manager I, Pediatric and Adult Care Coordination
Elevance Health
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Full Time
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a day ago
Elevance Health
Perform behavioral health and substance abuse case management via telephone or home visits. Assess member needs, develop and monitor care plans, and coordinate with internal and external resources to ensure quality care.
Investigate and process medical necessity appeals requests from members and providers. Prepare recommendations to uphold or deny appeals and ensure resolution within regulatory timeframes.
Verifies member information and educates patients on prescriptions, medication resources, and adherence to improve health outcomes. Conducts outreach to members and providers to close care gaps and assist with preventive screenings.
The Project Manager identifies and implements small to medium projects to achieve organizational goals and resolve complex problems. This includes managing project plans, documenting standard operating procedures, and collaborating with cross-functional teams to enhance operational efficiency.
The analyst will drive service quality excellence by evaluating interactions and developing performance reports to support departmental goals. They will also monitor improvement efforts and provide administrative support to the management team.
The Nurse Case Manager I performs care management for members with complex and chronic needs by developing and monitoring individualized care plans. Responsibilities include coordinating internal and external resources and interfacing with Medical Directors to optimize member health outcomes.
Perform care management for members with complex and chronic needs by assessing, implementing, and monitoring personalized care plans. Coordinate internal and external resources and collaborate with providers to optimize member health outcomes telephonically.
The Associate Medical Director supports medical management staff by ensuring timely and consistent medical necessity decisions for members and providers. Responsibilities include conducting clinical case reviews, making physician-to-physician calls, and handling grievances and appeals within their specialty.
The Nurse Appeals Lead investigates complex member and provider grievances and appeals to determine medical necessity. They provide leadership to appeals staff and serve as a subject matter expert for medical policy development.
Investigate and process medical necessity appeals requests from members and providers. Prepare recommendations for the Medical Director and ensure all grievances are resolved within regulatory timeframes.
Perform care management for members with complex and chronic needs by assessing, implementing, and monitoring personalized care plans. Coordinate with medical groups, providers, and community resources to optimize member health and facilitate discharge planning.
Transitions of Care RN 100% Virtual, CareBridge - Bilingual Preferred
Elevance Health
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Full Time
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3 days ago
Elevance Health
The role involves delivering patient education and disease management interventions through health coaching for members with chronic diseases. Responsibilities include conducting clinical assessments, implementing care plans, and coordinating with healthcare providers to improve member health outcomes.
The role involves verifying member information, educating patients on medication adherence, and assisting with prescription resources. The technician will perform outreach to members and providers to close care gaps and improve health outcomes.
Perform telephonic care management for members with complex and chronic needs by assessing, implementing, and monitoring personalized care plans. Coordinate internal and external resources and interface with Medical Directors to optimize member healthcare outcomes.
Nurse Practitioner 100% Virtual, CareBridge (Congregate Facilities)
Elevance Health
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Full Time
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6 days ago
Elevance Health
Collaborate with physicians and families to develop and implement complex clinical plans of care for adult patients with chronic conditions. Provide primary and urgent healthcare via telephone and video modalities while maintaining detailed medical documentation.
Perform cost report desk reviews and assist with audits in accordance with Government Auditing Standards and CMS requirements. Analyze provider financial statements and trial balances to make recommendations for change based on judgment and experience.
Diagnosis Related Group Clinical Validation Auditor-RN (CDI, MS-DRG, AP-DRG and APR-DRG)
Elevance Health
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Full Time
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6 days ago
Elevance Health
Responsible for auditing inpatient medical records to ensure clinical documentation supports the billed Diagnosis Related Groups (DRGs). The role involves analyzing claims using coding principles and clinical guidelines to identify documentation errors and suggest process improvements.
CareBridge Advance Practice Provider, Nurse Practitioner
Elevance Health
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Full Time
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6 days ago
Elevance Health
Collaborate with physicians and families to develop and implement complex clinical care plans for adult patients with chronic conditions. Provide primary and urgent healthcare via telephone and video modalities while coordinating resources and maintaining medical records.
The LPN/LVN is responsible for examining and treating patients under physician direction, including reviewing medical records and providing nursing interventions. The role involves significant telephonic engagement with patients and facilitating transfers to alternate levels of care.
Collaborate with health plan beneficiaries and providers to drive personalized health management and improve health outcomes. Conduct clinical assessments to develop, implement, and monitor care plans while coordinating with internal and external partners.
Orthopedic Surgery Associate Medical Director
Elevance Health
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Full Time
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13 days ago
Elevance Health
The role involves performing pre-authorizations and physician-level case reviews for musculoskeletal procedures to determine medical necessity. It also requires conducting peer-to-peer consultations and providing clinical education to internal staff and ordering physicians.
Perform care management for members with complex and chronic needs by assessing, implementing, and monitoring personalized care plans. Coordinate with medical groups, providers, and community resources to optimize member health and facilitate discharge planning.
Diagnosis Related Group Clinical Validation Auditor-RN (CDI, MS-DRG, AP-DRG and APR-DRG)
Elevance Health
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Full Time
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14 days ago
Elevance Health
The auditor is responsible for reviewing inpatient medical records to ensure clinical documentation supports the billed DRGs and reimbursed conditions. This includes analyzing claims using coding principles and clinical guidelines to identify documentation errors and suggest process improvements.
The Community Engagement Navigator engages with members to remove barriers related to Social Determinants of Health (SDOH). They act as a communication liaison between the company and referral sources to align individualized plans with case management efforts.
Associate Medical Director - Outpatient Rehab
Elevance Health
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Full Time
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14 days ago
Elevance Health
The Associate Medical Director supports medical management staff by ensuring timely and consistent medical necessity decisions for members and providers. This includes conducting clinical case reviews, making physician-to-physician calls, and handling grievances and appeals.
Medical Management Clinician Associate-Licensed Nurse
Elevance Health
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Full Time
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16 days ago
Elevance Health
The associate ensures consistent administration of plan benefits by reviewing clinical information and assessing medical necessity. They conduct precertification and treatment setting reviews for less complex benefit plans using clinical guidelines and scripted algorithms.
Provides technical direction, workload planning, and mentoring for associates while reviewing work to ensure adherence to guidelines. Handles complex case research, supports the Appeal Unit, and monitors inventory to ensure uninterrupted workflow.
Nurse Practitioner 100% Virtual, CareBridge
Elevance Health
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Full Time
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23 days ago
Elevance Health
Collaborate with physicians and families to develop and implement complex clinical care plans for adult patients with chronic conditions. Provide urgent healthcare via telephone and video modalities while maintaining detailed medical records and coordinating with inter-disciplinary teams.
Bilingual Nurse Practitioner 100% Virtual, CareBridge
Elevance Health
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Full Time
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a month ago
Elevance Health
Collaborate with providers and families to develop complex care plans for adult patients with chronic conditions via virtual modalities. Provide urgent healthcare, manage medication, and coordinate resources to maximize patient health and independence.
The Behavioral Health Care Manager I conducts utilization management reviews for mental health and substance use disorder benefits. This includes assessing member needs and coordinating care to promote quality outcomes and effective use of health benefits.
The Behavioral Health Care Manager II is responsible for managing psychiatric and substance abuse treatment through telephonic or written review. This role involves assessing member needs, coordinating care, and promoting effective use of health benefits.
