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Posted: 10/17/2026Transplant Nurse II
Elevance HealthCore 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, including care plan development, assessment of medical necessity, and collaboration with healthcare providers. Proficient in navigating health insurance benefits and regulatory requirements to ensure quality healthcare access.
Highest-signal resume keywords
RN LicenseClinical ExperienceCare Management CertificationMedical Management Process KnowledgeHealth Insurance Knowledge
About the role
Key responsibilities & impact- Provide case and/or medical management for members receiving transplant services
- Assess, develop, implement, coordinate, monitor, and evaluate care plans across the care continuum
- Conduct assessments to identify individual needs and develop care management plans
- Facilitate authorizations and referrals within benefit structures or through extra-contractual arrangements
- 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 care management treatment plans
- Assist with provider, claims, or service issue problem solving
- Assist with development of utilization and care management policies and procedures
- Collaborate with healthcare providers and members on complex medical transplant issues
- Assess medical necessity of inpatient admissions, outpatient services, surgical and diagnostic 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 healthcare in cost-effective settings
- Consult with clinical reviewers and medical directors throughout the medical management process
- Collaborate with providers on early discharge planning and proactive care transitions
- Facilitate member care transitions and refer treatment plans 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
- Must be able to be licensed in multiple states in a timely basis
- BA/BS or higher in a health-related field preferred
- 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 associates performing medical management
- Knowledge of health insurance/benefits strongly preferred
- Day shift availability, including both Saturday and Sunday
- New candidates in certain patient/member-facing roles must become vaccinated against COVID-19 and Influenza, 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) + match
- Stock purchase plan
- Life insurance
- Wellness programs
- Financial education resources
- Virtual full-time work, except required in-person training sessions
- Maximum flexibility and autonomy
- Work-life integration
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 Plan DevelopmentAssessment and EvaluationUtilization ManagementPre-Certification ReviewsCare Transition FacilitationProblem SolvingAccreditation Standards ApplicationMedical Necessity AssessmentReferral CoordinationCare Coordination
Soft Skills
CollaborationCommunicationCritical ThinkingInterpersonal SkillsOrganizational Skills
Certifications & Qualifications
Care Manager Certification
Industry Keywords
Transplant ServicesManaged CareHealthcare ProvidersMember BenefitsClinical ReviewCost-Effective HealthcareRegulatory RequirementsHealthcare AccreditationInpatient AdmissionsOutpatient Services