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Nurse Care Manager I – Nclex
Elevance Health. Collaborate with healthcare providers and/or consumers to drive personalized health management and improve health outcomes .
Core Competencies
Role fitCore Competencies
Use this summary to align your resume positioning with the role.
Demonstrates expertise in care management, clinical assessments, and developing individualized care plans while effectively collaborating with healthcare providers and consumers. Proficient in bilingual communication in English and Spanish to enhance patient engagement and support health outcomes.
Highest-signal resume keywords
RN LicenseAcute Care Clinical ExperienceCare ManagementClinical AssessmentBilingual Communication
ATS Keywords
Tailor your resumeApplicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills
Care Management ActivitiesClinical AssessmentsIndividualized Care PlansMonitoring Care Plan EffectivenessDischarge PlanningMedical Necessity AssessmentTreatment Setting AppropriatenessIntervention PlanningPatient Needs AssessmentProactive Discharge Planning
Soft Skills
CollaborationCommunicationProblem-SolvingCustomer ServiceAdaptability
Certifications & Qualifications
NCLEX CertificationCase Manager Certification
Industry Keywords
Healthcare ProvidersChronic Care ManagementHome HealthURAC AccreditationPatient EngagementCOVID-19 VaccinationInfluenza Vaccination
About the role
Key responsibilities & impact- Collaborate with healthcare providers and/or consumers to drive personalized health management and improve health outcomes
- Perform care management activities within the scope of licensure for members with complex and chronic care needs
- Assess medical necessity of inpatient admissions and extensions of stay
- Assess medical necessity of outpatient services and out-of-network services
- Assess appropriateness of treatment setting and level of care
- Partner with physician clinical reviewers and/or medical directors on care appropriateness, intervention planning, and clinical guidance
- Collaborate with providers to assess consumer needs for early identification and proactive discharge planning
- Conduct clinical assessments to develop individualized goals
- Develop and implement care plans
- Monitor and evaluate care plan effectiveness
- Modify care management plans as necessary
- Provide clear and precise answers to customer queries in a bilingual Spanish and English call center
Requirements
What you’ll need- High school diploma or equivalent
- Minimum of 3 years of acute care clinical experience
- Current, active, valid, unrestricted RN license in applicable state(s)
- Multi-state licensure required when providing services in multiple states
- Fully bilingual in English and Spanish preferred
- Ability to write, read, and speak English and Spanish with proficiency preferred
- Associate or bachelor's degree in nursing strongly preferred
- NCLEX certification or current unrestricted RN license from one of the 50 United States highly preferred
- Home health or discharge planning experience preferred
- Case Manager certification or bachelor's degree in a health or human services-related field preferred
- For URAC-accredited areas: 3 years full-time equivalent of direct clinical care experience required; 5 years preferred
- For URAC-accredited areas: current and active RN license allowing independent assessment within scope of practice required
- Ability to work rotating 8-hour shifts between 8:30 a.m. and 8:30 p.m. ET, Monday through Friday
- Additional hours, including weekends or holidays, may be required based on operational needs
- Must reside within a reasonable commuting distance from the posting location(s), unless an accommodation is granted as required by law
- Certain patient/member-facing roles require COVID-19 and Influenza vaccination unless an acceptable explanation is provided
Benefits
Comp & perks- Merit increases
- Paid holidays
- Paid Time Off
- Incentive bonus programs
- Medical benefits
- Dental benefits
- Vision benefits
- Short-term disability benefits
- Long-term disability benefits
- 401(k) with employer match
- Stock purchase plan
- Life insurance
- Wellness programs
- Financial education resources
- Virtual full-time work, except for required in-person training sessions
- Flexible work-life integration
- Professional and personal growth opportunities