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Transplant Nurse II
Elevance Health. Provide case and/or medical management for members receiving transplant services .
Core Competencies
Role fitCore Competencies
Use this summary to align your resume positioning with the role.
Demonstrates expertise in case and medical management for transplant services, with a strong focus on developing and implementing care management plans, assessing medical necessity, and collaborating with healthcare providers to ensure quality outcomes. Holds a current RN license and possesses knowledge of health insurance and medical management processes.
Highest-signal resume keywords
RN LicenseClinical ExperienceCare ManagementMedical Management ProcessOncology/Hematology Knowledge
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 PlansMedical Necessity AssessmentPre-Certification ReviewsUtilization ManagementTreatment Setting Appropriateness Reviews
Soft Skills
CollaborationProblem-SolvingCommunication
Certifications & Qualifications
Care Manager Certification
Industry Keywords
Transplant ServicesHealth InsuranceManaged Care ProductsAccreditation StandardsClinical Acumen
About the role
Key responsibilities & impact- Provide case and/or medical management for members receiving transplant services
- Assess individual needs and develop specific care management plans
- Implement care plans by facilitating authorizations and referrals
- Coordinate internal and external resources to meet identified needs
- Monitor and evaluate care management plans and modify them as needed
- Interface with Medical Directors and Physician Advisors on treatment plans
- Assist with provider, claims, and service issue resolution
- Assist with development of utilization/care management policies and procedures
- Collaborate with healthcare providers and members to promote quality outcomes and effective resource use
- Assess medical necessity of admissions, services, procedures, out-of-network services, and treatment settings
- Conduct pre-certification, retrospective, out-of-network, and treatment-setting appropriateness reviews
- Ensure access to medically necessary, quality, cost-effective healthcare
- Consult with clinical reviewers and medical directors throughout the medical management process
- Collaborate with providers on early identification and proactive discharge planning
- Facilitate member care transitions and refer plans of care to clinical reviewers as required
- Facilitate accreditation by applying accrediting and regulatory requirements and standards
- Continue learning and take on increasing peer-role assignments in preparation for advancement to the senior level
Requirements
What you’ll need- AS in nursing and minimum of 3 years of clinical experience; or any combination of education and experience providing an equivalent background
- Current unrestricted RN license in applicable state(s) required
- BA/BS or higher in a health-related field or certification as a care manager preferred
- Knowledge of medical management process and ability to interpret and apply member contracts, member benefits, and managed care products strongly preferred for medical management associates
- Must be able to be licensed in multiple states in a timely basis
- Knowledge of health insurance/benefits strongly preferred
- Strong clinical acumen
- Knowledge of oncology/hematology or stem cell and organ transplant preferred
- Candidates must reside within a reasonable commuting distance from a posting location unless an accommodation is granted
- Candidates in certain patient/member-facing roles must become vaccinated against COVID-19 and Influenza, unless an acceptable explanation is provided
- Monday–Friday availability, 8:00am–4:30pm EST
- Ability to work in applicable Eastern and Central time zone locations preferred
Benefits
Comp & perks- Comprehensive benefits package
- 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 match
- Stock purchase plan
- Life insurance
- Wellness programs
- Financial education resources
- Required in-person training sessions for virtual associates
- Incentive and recognition programs
- Equity stock purchase