Utilization review nurse jobs in Union City, NJ

Richmond Center is hiring a Registered Nurse (RN) Staff Educator in Staten Island, NY! Leads staff development programs; by providing instruction designed in safety, body mechanics, infection control, hazardous infectious materials, etc. to meet NYSDOH & other regulatory mandates Maintains educational practices by coaching, counseling, and may participate in disciplinary process; planning, monitoring, and appraising job results Maintains professional and technical knowledge by attending educational workshops; reviewing professional publications; establishing personal networks; participating in professional societies. Records and documents educational activity, attendance and responses Report on active projects, reactions, and progress daily, weekly and monthly. Participation in QAPI monthly meetings and projects Assist Director of Quality and or Director of Nursing in planning, coordinating and implementing staff programs and services to ensure a well-educated staff. Maintain appropriate records and assist in data collection for assessment and evaluation purposes Consults with and keeps Director of Quality and or Director of Nursing informed as appropriate or required Maintains close contact with employees off work, on disability or workman's compensation, and their physicians to facilitate their earliest possible return to work Reviews incident reports, OSHA reports, involving employees injured at work & coordinates education, loss prevention program with our safety program Provides annual tuberculosis screening of volunteers; directs follow-up procedure for positive Manitou testing within the scope of practice and under the direction of Director of Nursing. Administers Hep B vaccines & Mantoux (TB skin tests) to various contracted agencies and individuals per guidelines and under the direction of Director of Quality or Director of Nursing Requirements: Minimum 3 years of experience as a Nurse Educator in Long Term Care Current New York State Registered Nurse (RN) License Previous experience working in a long-term care setting Demonstrated ability to creatively educate and coach CPR certification required, CPR trainer certified or willing to become a trainer. Training in rehabilitative and restorative nursing practices Must possess the ability to interact, educate, coach and communicate with a wide cross-section of individuals in a courteous, tactful and effective manner Must possess the highest ethical standards with respect to discretion and regard for confidentiality Must possess an abiding commitment of basic ethical and legal principles Possess knowledge of emergency preparedness, safety, fire, disaster, OSHA Knowledgeable of infection control procedures About us: Richmond Center for Rehabilitation and Healthcare is a 372-bed rehabilitation and skilled nursing facility located in the borough of Staten Island. Our size enables a warm, nurturing environment, which allows each resident to maintain his/her individuality. Our staff is committed to ensuring the highest quality of life for all our residents, by maintaining each resident's dignity and independence. Richmond Center is a proud member of the Centers Health Care consortium. Equal Opportunity Employer -M/F/D/V

If you're a Nurse Practitioner or Physician Assistant tired of long shifts, rotating weekends, or high-stress hospital politics there's an opening in Hackensack that might change everything. • $50 $55/hour • No weekends or nights • Pediatric focus with a friendly physician and team • Includes a benefit package + 4% pension match This is one of those rare roles that lets you practice with purpose and peace. If you've got at least 1 year of experience, send your resume ASAP there's only one slot.

Registered Nurse - Mother Baby Nurse Salary: $90,000 per year (non-negotiable) with annual 3% cost of living increase Schedule: Full-time, Monday-Friday 9am - 5pm (35 hours per week) Additional Info: Mileage reimbursed, 14 paid holidays, strong benefits package About the Role: The Nurse-Family Partnership (NFP) program is a nationally recognized, evidence-based home-visiting program for first-time mothers and their families. As a Nurse Home Visitor, you will provide education, support, and case management from pregnancy through the child's second birthday. Key Responsibilities: Conduct home visits for first-time mothers and families in Northern Queens Build strong, goal-oriented relationships using motivational interviewing Assess physical, emotional, and social needs to create individualized care plans Coordinate community referrals and follow up to ensure services are received Maintain thorough and accurate documentation for Medicaid billing Qualifications: Current New York State RN license (in good standing) BSN or ASN Required Bilingual in English and Spanish CPR certification required Valid driver's license and insured vehicle Strong communication and computer skills Benefits: Hybrid work schedule Generous paid time off and 14 paid holidays Medical, dental, and vision coverage Ongoing training and professional development Supportive, mission-driven workplace that values work-life balance

Job Title: Nurse Coordinator RN Department Name: Medical-Surgical Unit-III1West Status: Salaried Shift: Evening Pay Range: $100,672.00 - $128,877.00 per year Pay Transparency: The above reflects the anticipated annual salary range for this position if hired to work in New Jersey. The compensation offered to the candidate selected for the position will depend on several factors, including the candidate's educational background, skills and professional experience. RWJBarnabas Health is looking to add a RN Clinical Coordinator in Elizabeth, NJ, Job Overview: Trinitas Regional Medical Center, established in 2000 through the consolidation of Elizabeth General Medical Center and St. Elizabeth Hospital, operates as a Catholic teaching hospital under the oversight of the Sisters of Charity of St. Elizabeth. Situated in Elizabeth, NJ, the hospital serves a population exceeding 129,000, offering comprehensive healthcare across two campuses. With 554 beds, including facilities for long-term care and behavioral health, Trinitas annually treats nearly 20,000 inpatients, 70,000 emergency patients and accommodates over 450,000 outpatient visits. Committed to God's healing mission, Trinitas prioritizes excellent, compassionate care, particularly for the poor and vulnerable, exemplified by its status as a leading Charity Care provider in the state. Trinitas is recognized for excellence across 12 Centers of Excellence, ranging from cardiology to sleep medicine. Qualifications: Required: ASN or Nursing Diploma Strong communication and organizational skills Proficient computer skills 3-5 Med./Surg, Telemetry nursing experience Preferred: National nursing certifications in area of specialty Certifications and Licenses Required: BLS, ACLS, and PALS through American Heart Association upon hire Active New Jersey Registered Nurse License or active Compact Registered Nurse License with New Jersey endorsement Scheduling Requirements: Evening Shift, 3p-11:30p Full Time, 40 hours per week Monday - Friday, every other weekend and holiday rotation may be required based on unit staffing needs Essential Functions: Trinitas Regional Medical Center supports a 38 Bed Medical Surgical Unit with a broad range of patient care needs and often supports some higher-acuity patients. The Nurse Coordinator in compliance monitoring Collaborates with health access dept and other units regarding bed coordination Provides input regarding objective observations related to staff evaluations; actively works with preceptors and Nurse Manager regarding orientation process and mentoring of new staff. Other Duties: Please note this job description is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities that are required of the employee for this job. Duties, responsibilities and activities may change at any time with or without notice. Benefits and Perks: At RWJBarnabas Health, our employees are at the heart of everything we do. Driven by our Total Wellbeing promise, our market-competitive offerings include comprehensive benefits and resources to support our employees physical, emotional, financial, personal, career, and community wellbeing. These benefits and resources include, but are not limited to: Paid Time Off including Vacation, Holidays, and Sick Time Retirement Plans Medical and Prescription Drug Insurance Dental and Vision Insurance Disability and Life Insurance Paid Parental Leave Tuition Reimbursement Student Loan Planning Support Flexible Spending Accounts Wellness Programs Voluntary Benefits (e.g., Pet Insurance) Community and Volunteer Opportunities Discounts Through our Partners such as NJ Devils, NJ PAC, and Verizon .and more! Choosing RWJBarnabas Health! RWJBarnabas Health is the premier health care destination providing patient-centered, high-quality academic medicine in a compassionate and equitable manner, while delivering a best-in-class work experience to every member of the team. We honor and appreciate the privilege of creating and sustaining healthier communities, one person and one community at a time. As the leading academic health system in New Jersey, we advance innovative strategies in high-quality patient care, education, and research to address both the clinical and social determinants of health. RWJBarnabas Health aims to truly make a unique impact in local communities throughout New Jersey. From vastly improving the health of local residents to creating educational and career opportunities, this combination greatly benefits the state. We understand the growing and evolving needs of residents in New Jersey-whether that be enhancing the coordination for treating complex health conditions or improving community health through local programs and education. Equal Opportunity Employer

One of the largest health benefits companies in the United States. Through its networks nationwide, the company delivers a number of leading health benefit solutions through a broad portfolio of integrated health care plans and related services, along with a wide range of specialty products such as life and disability insurance benefits, dental, vision, behavioral health benefit services, as well as long term care insurance and flexible spending accounts. Headquartered in Indianapolis, Indiana, WellPoint, Inc. is an independent licensee of the Blue Cross and Blue Shield Association serving members in California, Colorado, Connecticut, Georgia, Indiana, Kentucky, Maine, Missouri, Nevada, New Hampshire, New York, Ohio, Virginia and Wisconsin; and specialty plan members in other states through UniCare. Job Description This role is specific to the LTSS department. RN will be responsible for providing case management services and evaluating the necessity/appropriateness/efficiency of the use of Medical Services for Long-Term Support Services (LTSS). Will be responsible for collaborating with providers and members to promote quality member outcomes, to optimize member benefits, and to promote effective use of resources. May also manage appeals for services denied. Provides plan of care for members based on authorization and concurrent review. Provides monthly telephonic outreach to ensure members needs are assessed and met based on information. Responsible for collaborating with healthcare providers and members to promote quality member outcomes, to optimize member benefits, and to promote effective use of resources. MAJOR JOB DUTIES AND RESPONSIBILITIES Ensures medically appropriate, high quality, cost effective care through assessing the medical necessity of inpatient admissions, outpatient services, focused surgical and diagnostic procedures, out of network services, and appropriateness of treatment setting by utilizing the applicable medical policy and industry standards, accurately interpreting benefits and managed care products, and steering members to appropriate providers, programs, or community resources. Applies clinical knowledge to work with facilities and providers for care coordination. Works with medical directors in interpreting appropriateness of care and accurate claims payment. May also manage appeals for services denied. Conducts pre-certification, inpatient, retrospective, out of network and appropriateness of treatment setting reviews to ensure compliance with applicable criteria, medical policy, and member eligibility, benefits, and contracts. Ensures member access to medical necessary, quality healthcare in a cost effective setting according to contract. Consult with clinical reviewers and/or medical directors to ensure medically appropriate, high quality, cost effective care throughout the medical management process. Collaborates with providers to assess member's needs for early identification of and proactive planning for discharge planning. Facilitates member care transition through the healthcare continuum and refers treatment plans/plan of care to clinical reviewers as required and does not issue non-certifications. Facilitates accreditation by knowing, understanding, correctly interpreting, and accurately applying accrediting and regulatory requirements and standards. Additional Info: *possible remote opportunity after training if candidate demonstrates understanding of processes and policy expectations* Qualifications Must have clear and active RN license in the state of NY Requires an AS/BS in Nursing At least 2 years of acute care clinical experience; or any combination of EDU/experience that would provide an equivalent background Excellent written and verbal communication skills Additional Information Advantages of this Opportunity: Competitive salary, negotiable based on relevant experience Benefits offered, Medical, Dental, and Vision Fun and positive work environment Monday through Friday 8am-5pm

Job Description We're seeking experienced Utility Management Nurses to support a client's healthcare product development by leveraging expertise in insurance coding and hospital revenue management workflows. This role involves collaborating with hospital systems to align medical documentation with insurance policies, ensuring accurate coding and optimal reimbursement outcomes. Key Responsibilities Insurance Coding & Revenue Cycle Alignment: Review, audit, and optimize insurance coding practices across hospital systems to ensure compliance and maximize reimbursement accuracy. Workflow Analysis: Evaluate existing revenue management workflows and recommend improvements tailored to client's AI-driven documentation tools. Clinical Data Interpretation: Translate complex clinical notes into standardized coding formats (ICD-10, CPT, HCPCS) aligned with payer policies. Policy Matching: Assess coding accuracy against insurance guidelines and payer documentation requirements. Product Development Collaboration: Work closely with client's engineering and product teams to refine AI models that automate or assist with medical coding and documentation. Compliance & Quality Assurance: Ensure alignment with HIPAA, CMS, and payer-specific coding regulations. Required Qualifications Licensure: Registered Nurse (RN) or equivalent clinical background. Experience: Minimum 3-5 years in medical coding, clinical documentation improvement (CDI), or revenue cycle management. Certifications: CPC, CCS, or CRC certification preferred. Domain Expertise: Familiarity with hospital billing systems, payer policy interpretation, and coding audit procedures. Analytical Skills: Strong understanding of clinical documentation standards and payer logic. Tech Savvy: Comfortable working with EHR systems (Epic, Cerner, Meditech) and documentation review software. Preferred Qualifications Experience working within hospital revenue integrity teams or insurance utilization management. Exposure to AI-powered healthcare documentation tools or automated coding systems. Ability to identify and flag edge cases or policy exceptions in automated workflows. Strong collaboration skills with cross-functional (engineering, compliance, and data) teams. Engagement Model Contract / Part-time (Remote/In person) - Flexible hours with collaboration during U.S. business hours. In person in San Francisco is a plus

The Utilization Management Nurse will conduct reviews of current inpatient services, and determine medical appropriateness of inpatient and outpatient services following evaluation of medical guidelines and benefit determination in accordance with Utilization Management policies and procedures. ESSENTIAL FUNCTIONS Perform utilization management, utilization review, or concurrent review (on-site at a hospital, or telephonic inpatient care management) of hospitalized members ensuring medical necessity, appropriateness of admission, and continued stay following evaluation of medical and benefit determination guidelines. Maintains compliance with all state mandated regulations. Collaboration with hospital staff, physicians, care/service coordinators, plan Medical Director, members and their families to provide the level of care necessary to meet member's health needs. Maintain an active role in assuring the continuity of care for all inpatients through early discharge planning and working with hospital discharge planners and health plan social workers or other staff in the early identification of potential home care candidates or less restrictive level of care placement. Identification and management of members at high risk for readmission or with complex medical and psychosocial needs. Collaboration with Case Manager to coordinate post discharge care and services aimed at: increasing rates of timely outpatient follow-up, ensuring provider treatment plan, medications & outpatient services are in place, safe transition to outpatient setting, improving self management skills, addressing members psychosocial and non-medical needs Communicate directly with physician providers/designees when appropriate to gather all clinical information to determine the medical necessity of requested healthcare services. Maintains courteous, professional attitude when working with Affinity staff, hospital and physician providers, and members. Collect pertinent clinical information and documents all UM review information using the appropriate software system. Manage medical / benefits resources effectively and efficiently while ensuring quality care is provided as determined by guidelines of meeting Medical necessity. Communicate directly with appropriate internal staff regarding all inpatient cases and outpatient/ambulatory requests for health care services that do not meet medical necessity or appropriate level of care and out of network transfer issues. Manage assigned workload within established performance standards. Follow relevant client time frame standards for conducting and communicating UM review determination. Maintain and submit reports and logs on review activities as outlined by the UM program operational procedures. Contribute to MM program goals and objectives in containing health care costs and maintaining a high quality medical delivery system through the program procedures for conducting UM activities. Participate in a multi-disciplinary team approach to address member needs from the acute care phase through the post-acute care phase. Identify and coordinate quality of care issues or trends with the Quality Management department. Demonstrate proficiency with the principles and methodologies of process improvement. Apply these in the execution of responsibilities in support of a process focused approach. Perform other duties as necessary or assigned. QUALIFICATIONS: Registered Nurse or Licensed Practical Nurse with current, unrestricted, licensure required for state of New York Associates degree in Nursing required; BSN preferred 3+ years Clinical experience and 2 or more years experience working in utilization management required Experience working in Medicaid and/or Medicare managed care, including regulatory and compliance requirements strongly preferred Experience with MCG guidelines preferred Proficiency in software applications that include, but are not limited to, Microsoft Word, Microsoft Excel, Microsoft PowerPoint and Outlook required Ability to work with minimal guidance; seeks guidance on only the most complex tasks Problem solving skills; the ability to systematically analyze problems, draw relevant conclusions and devise appropriate courses of action Excellent verbal and written communication skills; ability to speak clearly and concisely, conveying complex or technical information in a manner that others can understand, as well as ability to understand and interpret complex information from others. Advanced interpersonal (e.g., mediating, counseling, mentoring, influencing), negotiating and management skills required to manage critical internal and external relationships and activities that are diverse and complex. Ability to collaborate constructively with others within and outside the organization. Ability to work resourcefully and creatively, to think independently, and to exercise sound judgment in a complex and dynamic environment. Commitment to the corporate mission, vision, and values. High level of integrity as demonstrated by a) appropriate treatment of confidential information, b) adherence to policies, procedures, rules and regulations, c) professional conduct in dealing with persons internal and external to the organization, and d) sensitivity to the populations served by Affinity and the providers with which Affinity works.

Job DescriptionDescription: Tillman FiberCo is building a network with future-forward technologies, systems and network architecture that will be ultimately capable of delivering 40Gbps+ to customers. Tillman FiberCo is a portfolio company of Tillman Global Holdings, a holding company focused on building premier digital infrastructure businesses globally. We have an incredible opportunity for a Utility Coordinator to support the work in Hernando, Citrus, Sumter, Marion, Volusia, Seminole, Brevard, Palm Beach, Broward and Miami-Dade Counties. Ideal candidate location would be based in Osceola, St. Lucie, or Indian River County. Responsibilities: Oversee relations between our vendor and the jurisdictions as well as manage the quality and direction requested by the jurisdiction and intervene when necessary to ensure that permit requirements are being fulfilled. Only if it's an electrical permit. Ensure all permit payments are timely and invoiced appropriately and Audit and Maintain SFU/MDU OSP permits and ROW payment records in Sitetracker. Power company/construction invoices. Work with our vendor partners in getting utility accounts set up with power companies Review Utility and permit Work Plans and recommend for approval. Pertains to vetting the locations. As necessary, interfaces with jurisdictional staff to ensure compliance with applicable laws, codes, and ordinances, and leverage regulatory status to support deployment objectives. Tracks project progress and maintain accurate data entry. Communicate with the electrician. Acts as a point of contact for internal and external customers regarding specific power companies. Ensures all permits are submitted in a timely manner to ensure fiber build projects are not delayed. Additional Responsibilities: Identifying and resolving conflicts between existing utilities and proposed construction designs.?Field verification of proposed location and existing utilities. Travel to locations will be expected. Create utilities project work orders with all utility companies involved in projects. Communicate with engineers to ensure smooth interactions and project development. Collaborating with utility companies, project designers, and other stakeholders to ensure smooth coordination.?Develop working relationships with engineers and customer service. Maintaining accurate records of utility locations, drawings, and documentation.?Include design and permit prints, verify for accuracy. Trackers that include utilities milestones (permits for electrical, gas, water, etc.) submittal and approval dates. Managing the relocation of utilities, including obtaining necessary permits and ensuring compliance with regulations.? Providing support to design teams by attending meetings, reviewing documents, and facilitating site visits.? Tracking the progress of relocation efforts and ensuring timely completion.? Communicate with municipality personnel to identify projects that may affect project construction progress. Assisting with the preparation of contingency plans for unplanned utility events.? Identifying and locating utilities within project boundaries using various methods and technologies.? Preparing and reviewing utility agreements with utility companies.? Obtaining necessary permits for utility relocation and construction. Providing schedule oversight for utility work integrated with the overall construction schedule.? Conducting utility coordination meetings and documenting meeting minutes.? Communicate with customer service to initiate service accounts. In some instances, travel to the proposed construction locations is expected. Maintain a good driving record. Maintain service on company vehicle up to date. Requirements: What we are looking for Location: Must reside within the service area spanning the counties listed and be willing to travel regularly throughout these locations . Candidates outside the area will be considered only if able to relocate or travel frequently within the region. Experience: High school diploma or GED required. Minimum 2+ years of utility coordination experience with power companies (e.g., TECO, Duke Energy, FPL, KUA). Hands-on fielding experience strongly preferred, including: Vetting proposed cabinet locations Verifying transformer proximity Assessing site conditions (e.g., flood zones) Experience with and understanding of wireline technologies for OSP fiber builds (buried, aerial, underground). Knowledge of National Electrical Safety Code (NESC), Rural Utilities Service (RUS) codes, and relevant building codes is a plus. Technical Skills: Proficient in Microsoft Office and Adobe Acrobat. Working knowledge of Excel and Google Earth/Maps. Salesforce Sitetracker experience preferred. Key Competencies: Highly organized, self-starter with excellent time management and attention to detail. Strong written, verbal, and interpersonal communication skills, including negotiation, consensus building, and problem-solving. Ability to take direction, adapt to changing priorities, and work independently or collaboratively. Critical thinking skills to assess challenges, anticipate conflicts, and develop solutions. Additional Requirements: Valid driver's license with a clean MVR (Motor Vehicle Record). Ability to work 50% in the field (site vetting, coordination with engineers and power companies, attending meter set appointments) and 50% from home (updating SiteTracker, managing invoices/accounts, maintaining trackers, coordinating with internal teams). Willingness to travel within assigned geographic area. Successful completion of MVR check. As a growing company, we are committed to attracting and developing the absolute best talent by offering a workplace where results are recognized and rewarded. We offer a terrific opportunity for you to grow: Challenging, rewarding career within a growing company, backed by a global investor and owner of digital infrastructure assets. Competitive Salary East Coast based company (will work on EST time) Direct Hire Opportunity Collaborative environment, with on-the-job training and mentorship opportunities Competitive benefits and wellness package, including medical, dental and vision coverage. 401k plan with company match Generous PTO and 11 holidays annually Paid parental leave. Employee Recognition Program

About Us We're Maimonides Health, Brooklyn's largest healthcare system, serving over 250,000 patients each year through the system's 3 hospitals, 1800 physicians and healthcare professionals, more than 80 community-based practices and outpatient centers. At Maimonides Health, our core values H.E.A.R.T drives everything we do. We uphold and maintain Honesty, Empathy, Accountability, Respect, and Teamwork to empower our talented team, engage our respective communities and adhere to Planetree's philosophy of patient-centered care. The system is anchored by Maimonides Medical Center, one of the nation's largest independent teaching hospitals and home to centers of excellence in numerous specialties; Maimonides Midwood Community Hospital (formerly New York Community Hospital), a 130-bed adult medical-surgical hospital; and Maimonides Children's Hospital, Brooklyn's only children's hospital and only pediatric trauma center. Maimonides' clincal progams rank among the best in the country for patient outcomes, including its Heart and Vascular Institute, Neuroscience Institute, Boneand Joint Center, and Cancer Center. Maimonides is an affiliate of Northwell Health and a major clinical training site for SUNY Downstate College of Medicine. Overview The Manager has overall day-to-day responsibility for directing, supervising and managing the activities of the Case Management Team. Responsibilities The Manager has overall day-to-day responsibility for directing, supervising and managing the activities of the Case Management Team. Facilitates the Hospital's goals of reducing length of stay, improving patient care, efficient and effective utilization of resources to ensure appropriate continuum of care of patients. Functions as resource person and troubleshooter for case management team and discharge planning regarding barriers to discharge. Acts as liaison with nursing and medical staff and other clinical departments to integrate the department's functions and services with other aspects of the patient care process. Qualifications * Current and valid NYS RN licensure required. * BSN Required. MSN preferred. * 3-5 years Clinical Experience (Med/Surg acute care) required. * CCM preferred. * Minimum of 3 years of direct experience in utilization management, discharge planning, case management or home care required. * Minimum of 2 years of leadership or managerial experience in a healthcare environment, preferred. * Proficiency with case management software and EMRs (e.g., Allscripts, Sunrise, or equivalent) preferred. * Current clinical and technical nursing skills. * Knowledge of rules and regulations of child abuse/neglect reporting as appropriate. * Knowledge with requirements of regulatory agencies and third-party payors. * Demonstrated ability to use word processing, spreadsheet and/or database programs as required by the position. * Excellent oral and written communication skills. * Excellent interpersonal skills. * Good problem-solving, decision-making and judgment skills. * Must read, write and speak English to the extent required by position. Pay Range USD $148,000.00 - USD $160,000.00 /Yr. Equal Employment Opportunity Employer Maimonides Medical Center (MMC) is an equal opportunity employer.

Leading Westchester, NY hospital seeks an acute care nurse to work as a Nurse Case Manager. Responsibilities : Perform the initial comprehensive assessment on admission in accordance with the Care Management Department policies. Screen all patients by utilizing established tools for high risk indicators to ensure high risk patient populations receive the appropriate supportive services for discharge to prevent readmission and assess all populations for potential discharge planning needs. Provides ongoing reassessment of needs throughout the hospital course. Performs UR activity per department policy. Perform activities for multidisciplinary care coordination at the intra-hospital level of care and inter-hospital level of care. Communicates and collaborates all relevant patient information to appropriate health team members. Qualifications: Licensed Registered Nurse Bachelor's Degree in Nursing A minimum of 5 years of acute care experience in ED, critical care or med/surg This is an excellent opportunity for an experienced acute care nurse looking to move away from the bedside. Salary: $119,000 - $154,000 Please email resume to: Joshua Albucker Senior Vice President NOOR Staffing Group 646-492-5653 jalbucker@noorstaffing.com

**Telephonic Nurse Case Manager II** **Location:** This role enables associates to work virtually full-time, with the exception of required in-person training sessions, providing maximum flexibility and autonomy. This approach promotes productivity, supports work-life integration, and ensures essential face-to-face onboarding and skill development. Alternate locations may be considered if candidates reside within a commuting distance from an office. Please note that per our policy on hybrid/virtual work, candidates not within a reasonable commuting distance from the posting location(s) will not be considered for employment, unless an accommodation is granted as required by law. **Hours:** Monday - Friday 9:00am to 5:30pm EST and 1 late evening 11:30am to 8:00pm EST. **_***This position requires an on-line pre-employment skills assessment. The assessment is free of charge and can be taken from any PC with Internet access. Candidates who meet the minimum requirements will be contacted via email with instructions. In order to move forward in the process, you must complete the assessment within 48 hours of receipt and meet the criteria._** The **Telephonic Nurse Case Manager II** is responsible for care management within the scope of licensure for members with complex and chronic care needs by assessing, developing, implementing, coordinating, monitoring, and evaluating care plans designed to optimize member health care across the care continuum. Performs duties telephonically. **How you will make an impact:** + Ensures member access to services appropriate to their health needs. + Conducts assessments to identify individual needs and a specific care management plan to address objectives and goals as identified during assessment. + Implements care plan by facilitating authorizations/referrals as appropriate within benefits structure or through extra-contractual arrangements. + Coordinates internal and external resources to meet identified needs. + Monitors and evaluates effectiveness of the care management plan and modifies as necessary. + Interfaces with Medical Directors and Physician Advisors on the development of care management treatment plans. + Negotiates rates of reimbursement, as applicable. + Assists in problem solving with providers, claims or service issues. + Assists with development of utilization/care management policies and procedures. **Minimum requirements:** + Requires BA/BS in a health related field and minimum of 5 years of clinical experience; or any combination of education and experience, which would provide an equivalent background. + Current, unrestricted RN license in applicable state(s) required. + Multi-state licensure is required if this individual is providing services in multiple states. _For URAC accredited areas the following applies: Requires a BA/BS and minimum of 5 years of clinical care experience; or any combination of education and experience, which would provide an equivalent background. Current and active RN license required in applicable state(s). Multi-state licensure is required if this individual is providing services in multiple states._ **Preferred Capabilities, Skills, and Experiences:** + Certification as a Case Manager preferred. + Ability to talk and type at the same time preferred. + Demonstrate critical thinking skills when interacting with members preferred. + Experience with (Microsoft Office) and/or ability to learn new computer programs/systems/software quickly preferred. + Ability to manage, review and respond to emails/instant messages in a timely fashion preferred. + Minimum 2 years' experience in acute care setting preferred. + Minimum 2 years' "telephonic" Case Management experience with a Managed Care Company preferred. + Managed Care experience preferred. For candidates working in person or virtually in the below location(s), the salary* range for this specific position is $76,944 to $126,408 Locations: Colorado, Maryland, Massachusetts, New Jersey, Washington State In addition to your salary, Elevance Health offers benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). The salary offered for this specific position is based on a number of legitimate, non-discriminatory factors set by the Company. The Company is fully committed to ensuring equal pay opportunities for equal work regardless of gender, race, or any other category protected by federal, state, and local pay equity laws. * The salary range is the range Elevance Health in good faith believes is the range of possible compensation for this role at the time of this posting. This range may be modified in the future and actual compensation may vary from posting based on geographic location, work experience, education and/or skill level. Even within the range, the actual compensation will vary depending on the above factors as well as market/business considerations. No amount is considered to be wages or compensation until such amount is earned, vested, and determinable under the terms and conditions of the applicable policies and plans. The amount and availability of any bonus, commission, benefits, or any other form of compensation and benefits that are allocable to a particular employee remains in the Company's sole discretion unless and until paid and may be modified at the Company's sole discretion, consistent with the law. Please be advised that Elevance Health only accepts resumes for compensation from agencies that have a signed agreement with Elevance Health. Any unsolicited resumes, including those submitted to hiring managers, are deemed to be the property of Elevance Health. Who We Are 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. How We Work At Elevance Health, we are creating a culture that is designed to advance our strategy but will also lead to personal and professional growth for our associates. Our values and behaviors are the root of our culture. They are how we achieve our strategy, power our business outcomes and drive our shared success - for our consumers, our associates, our communities and our business. We offer a range of market-competitive total rewards that include merit increases, paid holidays, Paid Time Off, and incentive bonus programs (unless covered by a collective bargaining agreement), medical, dental, vision, short and long term disability benefits, 401(k) +match, stock purchase plan, life insurance, wellness programs and financial education resources, to name a few. Elevance Health operates in a Hybrid Workforce Strategy. Unless specified as primarily virtual by the hiring manager, associates 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. The health of our associates and communities is a top priority for Elevance Health. We require all new candidates in certain patient/member-facing roles to become vaccinated against COVID-19 and Influenza. If you are not vaccinated, your offer will be rescinded unless you provide an acceptable explanation. Elevance Health will also follow all relevant federal, state and local laws. Elevance Health is an Equal Employment Opportunity employer and all qualified applicants will receive consideration for employment without regard to age, citizenship status, color, creed, disability, ethnicity, genetic information, gender (including gender identity and gender expression), marital status, national origin, race, religion, sex, sexual orientation, veteran status or any other status or condition protected by applicable federal, state, or local laws. Applicants who require accommodation to participate in the job application process may contact ******************************************** for assistance. Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state, and local laws, including, but not limited to, the Los Angeles County Fair Chance Ordinance and the California Fair Chance Act.

Location: This role enables associates to work virtually full-time, with the exception of required in-person training sessions, providing maximum flexibility and autonomy. This approach promotes productivity, supports work-life integration, and ensures essential face-to-face onboarding and skill development. Please note that per our policy on hybrid/virtual work, candidates not within a reasonable commuting distance from the posting location(s) will not be considered for employment, unless an accommodation is granted as required by law. Hours: Monday - Friday 9:00am to 5:30pm EST and 1 late evening 11:30am to 8:00pm EST. * This position will service members in different states; therefore, Multi-State Licensure will be required. This position requires an on-line pre-employment skills assessment. The assessment is free of charge and can be taken from any PC with Internet access. Candidates who meet the minimum requirements will be contacted via email with instructions. In order to move forward in the process, you must complete the assessment within 48 hours of receipt and meet the criteria. The Telephonic Nurse Case Manager II is responsible for care management within the scope of licensure for members with complex and chronic care needs by assessing, developing, implementing, coordinating, monitoring, and evaluating care plans designed to optimize member health care across the care continuum. Performs duties telephonically. How you will make an impact: * Ensures member access to services appropriate to their health needs. * Conducts assessments to identify individual needs and a specific care management plan to address objectives and goals as identified during assessment. * Implements care plan by facilitating authorizations/referrals as appropriate within benefits structure or through extra-contractual arrangements. * Coordinates internal and external resources to meet identified needs. * Monitors and evaluates effectiveness of the care management plan and modifies as necessary. * Interfaces with Medical Directors and Physician Advisors on the development of care management treatment plans. * Negotiates rates of reimbursement, as applicable. * Assists in problem solving with providers, claims or service issues. * Assists with development of utilization/care management policies and procedures. Minimum Requirements: * Requires BA/BS in a health-related field and minimum of 5 years of clinical experience; or any combination of education and experience, which would provide an equivalent background. * Current, unrestricted RN license in applicable state required. * Multi-state licensure is required if this individual is providing services in multiple states. Preferred Capabilities, Skills and Experiences: * Case Management experience. * Certification as a Case Manager. * Minimum 2 years' experience in acute care setting. * Managed Care experience. * Ability to talk and type at the same time. * Demonstrate critical thinking skills when interacting with members. * Experience with (Microsoft Office) and/or ability to learn new computer programs/systems/software quickly. * Ability to manage, review and respond to emails/instant messages in a timely fashion. For candidates working in person or virtually in the below locations, the salary* range for this specific position is $76,944 to $126.408. Locations: Colorado; New York; New Jersey In addition to your salary, Elevance Health offers benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). The salary offered for this specific position is based on a number of legitimate, non-discriminatory factors set by the Company. The Company is fully committed to ensuring equal pay opportunities for equal work regardless of gender, race, or any other category protected by federal, state, and local pay equity laws. * The salary range is the range Elevance Health in good faith believes is the range of possible compensation for this role at the time of this posting. This range may be modified in the future and actual compensation may vary from posting based on geographic location, work experience, education and/or skill level. Even within the range, the actual compensation will vary depending on the above factors as well as market/business considerations. No amount is considered to be wages or compensation until such amount is earned, vested, and determinable under the terms and conditions of the applicable policies and plans. The amount and availability of any bonus, commission, benefits, or any other form of compensation and benefits that are allocable to a particular employee remains in the Company's sole discretion unless and until paid and may be modified at the Company's sole discretion, consistent with the law. Please be advised that Elevance Health only accepts resumes for compensation from agencies that have a signed agreement with Elevance Health. Any unsolicited resumes, including those submitted to hiring managers, are deemed to be the property of Elevance Health. Who We Are 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. How We Work At Elevance Health, we are creating a culture that is designed to advance our strategy but will also lead to personal and professional growth for our associates. Our values and behaviors are the root of our culture. They are how we achieve our strategy, power our business outcomes and drive our shared success - for our consumers, our associates, our communities and our business. We offer a range of market-competitive total rewards that include merit increases, paid holidays, Paid Time Off, and incentive bonus programs (unless covered by a collective bargaining agreement), medical, dental, vision, short and long term disability benefits, 401(k) +match, stock purchase plan, life insurance, wellness programs and financial education resources, to name a few. Elevance Health operates in a Hybrid Workforce Strategy. Unless specified as primarily virtual by the hiring manager, associates 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. The health of our associates and communities is a top priority for Elevance Health. We require all new candidates in certain patient/member-facing roles to become vaccinated against COVID-19 and Influenza. If you are not vaccinated, your offer will be rescinded unless you provide an acceptable explanation. Elevance Health will also follow all relevant federal, state and local laws. Elevance Health is an Equal Employment Opportunity employer and all qualified applicants will receive consideration for employment without regard to age, citizenship status, color, creed, disability, ethnicity, genetic information, gender (including gender identity and gender expression), marital status, national origin, race, religion, sex, sexual orientation, veteran status or any other status or condition protected by applicable federal, state, or local laws. Applicants who require accommodation to participate in the job application process may contact ******************************************** for assistance. Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state, and local laws, including, but not limited to, the Los Angeles County Fair Chance Ordinance and the California Fair Chance Act.

Job Overview - Nurse Case Manager (RN or LPN): Compensation: $55/hour Schedule: Monday to Friday, 9:00 AM - 5:00 PM Step into a key role as a Nurse Case Manager with our client in White Plains, NY, delivering clinical support and coordinated care to youth and families. This full-time, on-site position is ideal for an RN or LPN with experience in pediatrics, med-surg, or community health. You'll oversee treatment plans, coordinate medical services, ensure medication adherence, and work closely with providers and families in a trauma-informed, holistic care environment. Responsibilities as the Nurse Case Manager (RN or LPN): Care Coordination: Schedule medical appointments, obtain records and consents, and ensure timely follow-up with community providers. Clinical Support: Deliver direct nursing care for residents experiencing illness or injury in a health center environment. Medication Management: Oversee MARs, track controlled substances, and coordinate pharmacy communications and deliveries. Health Education & Communication: Educate residents and families on medication adherence and serve as liaison with prescribers and caregivers. Regulatory Compliance: Maintain documentation standards and ensure alignment with healthcare regulations and agency protocols. Team Collaboration: Participate in case reviews and staff meetings, and support care through interdisciplinary communication and off-site visits. Qualifications for the Nurse Case Manager: Licensure: Active New York State RN or LPN license required. Education: Bachelor's degree in Nursing or a related field preferred. Experience: 1-2 years of experience in medical-surgical, pediatric, acute/sub-acute care, or visiting nurse services. Skills & Attributes: Strong communication and case management skills, with the ability to coordinate care across teams and maintain accurate documentation. Language Requirement: Bilingual in Spanish and English preferred. Application Notice: Qualified candidates will be contacted within 2 business days of application. If an applicant does not meet the above criteria, TAG MedStaffing will keep your resume on file for future opportunities and may contact you for further discussion.

A Growing Homecare Company is currently seeking compassionate and experienced Field Nurses to do home visits for our patients in all boroughs of New York. Our goal is to provide superior, compassionate home care workers and healthcare services for elderly and disabled individuals in the comfort and dignity of their homes. We work closely with hospitals, physicians, and private caregivers for hire to develop and coordinate an individual plan of care while maintaining their independence at home. The Field Nurse is responsible for providing professional nursing care to patients requiring in-home care. Responsibilities Assess the patient/family situation for nursing and health-related problems. Educate the patient/family regarding the disease process, self-care techniques, and prevention strategies. Document on a timely basis, all nursing services provided to patients as well as periodic reports to coordinate care and remain in compliance with state/federal regulations. Instruct and supervise patients, caregivers, and home health aides in aspects of patient care as appropriate. Perform other related duties as assigned. Qualifications 1-2 years of experience in Certified Home Health Agency (CHHA) or Long-term care preferred. New York State RN License Strong Assessment and Clinical Skills Bilingual in Mandarin is preferred. Professional Liability Insurance Able to drive an automobile in good working order and available for use in the field. Compensation Initial assessment visit = $130.00 Reassessment visit = $100.00 Resumption of Care visit = $100.00 Supervisory visit = $80.00 **Per Diem and Full-time positions available.

Location: This role enables associates to work virtually full-time, with the exception of required in-person training sessions, providing maximum flexibility and autonomy. This approach promotes productivity, supports work-life integration, and ensures essential face-to-face onboarding and skill development. Please note that per our policy on hybrid/virtual work, candidates not within a reasonable commuting distance from the posting location(s) will not be considered for employment, unless an accommodation is granted as required by law. Hours: Monday - Friday 9:00am to 5:30pm EST and 1 late evening 11:30am to 8:00pm EST. *****This position will service members in different states; therefore, Multi-State Licensure will be required. This position requires an on-line pre-employment skills assessment. The assessment is free of charge and can be taken from any PC with Internet access. Candidates who meet the minimum requirements will be contacted via email with instructions. In order to move forward in the process, you must complete the assessment within 48 hours of receipt and meet the criteria. The Telephonic Nurse Case Manager II is responsible for care management within the scope of licensure for members with complex and chronic care needs by assessing, developing, implementing, coordinating, monitoring, and evaluating care plans designed to optimize member health care across the care continuum. Performs duties telephonically. How you will make an impact: Ensures member access to services appropriate to their health needs. Conducts assessments to identify individual needs and a specific care management plan to address objectives and goals as identified during assessment. Implements care plan by facilitating authorizations/referrals as appropriate within benefits structure or through extra-contractual arrangements. Coordinates internal and external resources to meet identified needs. Monitors and evaluates effectiveness of the care management plan and modifies as necessary. Interfaces with Medical Directors and Physician Advisors on the development of care management treatment plans. Negotiates rates of reimbursement, as applicable. Assists in problem solving with providers, claims or service issues. Assists with development of utilization/care management policies and procedures. Minimum Requirements: Requires BA/BS in a health-related field and minimum of 5 years of clinical experience; or any combination of education and experience, which would provide an equivalent background. Current, unrestricted RN license in applicable state required. Multi-state licensure is required if this individual is providing services in multiple states. Preferred Capabilities, Skills and Experiences: Case Management experience. Certification as a Case Manager. Minimum 2 years' experience in acute care setting. Managed Care experience. Ability to talk and type at the same time. Demonstrate critical thinking skills when interacting with members. Experience with (Microsoft Office) and/or ability to learn new computer programs/systems/software quickly. Ability to manage, review and respond to emails/instant messages in a timely fashion. For candidates working in person or virtually in the below locations, the salary* range for this specific position is $76,944 to $126,408. Locations: Colorado; New York; New Jersey In addition to your salary, Elevance Health offers benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). The salary offered for this specific position is based on a number of legitimate, non-discriminatory factors set by the Company. The Company is fully committed to ensuring equal pay opportunities for equal work regardless of gender, race, or any other category protected by federal, state, and local pay equity laws. * The salary range is the range Elevance Health in good faith believes is the range of possible compensation for this role at the time of this posting. This range may be modified in the future and actual compensation may vary from posting based on geographic location, work experience, education and/or skill level. Even within the range, the actual compensation will vary depending on the above factors as well as market/business considerations. No amount is considered to be wages or compensation until such amount is earned, vested, and determinable under the terms and conditions of the applicable policies and plans. The amount and availability of any bonus, commission, benefits, or any other form of compensation and benefits that are allocable to a particular employee remains in the Company's sole discretion unless and until paid and may be modified at the Company's sole discretion, consistent with the law. Job Level: Non-Management Exempt Workshift: Job Family: MED > Licensed Nurse Please be advised that Elevance Health only accepts resumes for compensation from agencies that have a signed agreement with Elevance Health. Any unsolicited resumes, including those submitted to hiring managers, are deemed to be the property of Elevance Health. Who We Are 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. How We Work At Elevance Health, we are creating a culture that is designed to advance our strategy but will also lead to personal and professional growth for our associates. Our values and behaviors are the root of our culture. They are how we achieve our strategy, power our business outcomes and drive our shared success - for our consumers, our associates, our communities and our business. We offer a range of market-competitive total rewards that include merit increases, paid holidays, Paid Time Off, and incentive bonus programs (unless covered by a collective bargaining agreement), medical, dental, vision, short and long term disability benefits, 401(k) +match, stock purchase plan, life insurance, wellness programs and financial education resources, to name a few. Elevance Health operates in a Hybrid Workforce Strategy. Unless specified as primarily virtual by the hiring manager, associates 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. The health of our associates and communities is a top priority for Elevance Health. We require all new candidates in certain patient/member-facing roles to become vaccinated against COVID-19 and Influenza. If you are not vaccinated, your offer will be rescinded unless you provide an acceptable explanation. Elevance Health will also follow all relevant federal, state and local laws. Elevance Health is an Equal Employment Opportunity employer, and all qualified applicants will receive consideration for employment without regard to age, citizenship status, color, creed, disability, ethnicity, genetic information, gender (including gender identity and gender expression), marital status, national origin, race, religion, sex, sexual orientation, veteran status or any other status or condition protected by applicable federal, state, or local laws. Applicants who require accommodation to participate in the job application process may contact ******************************************** for assistance. Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state, and local laws, including, but not limited to, the Los Angeles County Fair Chance Ordinance and the California Fair Chance Act.

Oakland K-8 Public Schools Office of the Superintendent 315 Ramapo Valley Road Oakland, NJ 07436 ************** Employment Posting 2024-2025 School Year SUBSTITUTE NURSES * Current RN License * School Nurse License or County Credential * Understanding of child growth and development * Ability to communicate effectively with children and adults * Strong interpersonal skills * Ability to supervise children * Attention to detail * NJ Criminal Background Check and CPR/AED Certification required Candidates interested in this position should visit ************************ and click on "Employment Opportunities". Daily Rate of Pay $200.00 AN AFFIRMATIVE ACTION/EQUAL OPPORTUNITY EMPLOYER

Monarch/Brandywine Senior Living: Company Culture and Values: At Monarch Communities, we value compassion, innovation, and community. Our team is committed to making a meaningful impact on the lives of our residents and fostering a collaborative and supportive work environment. Job Description LPN - Brandywine Living - Livingston, NJ Salary: $34.00 - $36.00 Hourly Led by the community's Health and Wellness Director (RN), our Wellness Nurse is a Licensed Practical Nurse (LPN) who provides direct nursing care to the Residents with an emphasis on holistic wellness. They also help supervise the day-to-day nursing activities performed by care staff of Certified Nursing Assistants. Schedule: The Wellness Nurse (LPN) is Full-Time 3p-11p including every other weekend Responsibilities and Duties Monitors the health, safety, and well-being of all residents Assisting in training and monitoring of medication administration Supervise care staff in accordance with current state regulations and community policies Maintaining clinical quality assurance in accordance with federal, state and local standards Promote the highest degree of service to our residents while leading and demonstrating the mission of the company Conduct thorough resident assessments Qualifications Graduation from an accredited School of Nursing, with current LPN license At least 2 years' experience with long-term care, assisted living, home health or hospital setting preferred Experience working with residents with Alzheimer's or other related dementias Ability to handle multiple tasks Knowledge of federal and state regulations, and of nursing practices, techniques and methods applied to health and wellness resident Proficiency in computer skills, Microsoft Office (Windows, Outlook, Excel) with the ability to learn new applications While performing the duties of this job, the associate is often required to stand, walk, sit, use fine and gross motor skills, reach with hands and arms, balance, stoop, kneel, crouch, talk, hear, and smell. An individual in this position will be required to lift or carry weight in up to 50 lbs. Intermittent physical activity includes lifting and supporting residents. The associate must use proper body mechanics. Additional Information Benefits Offered (Full Time): Health Insurance: Medical/Rx, Dental, and Vision Ancillary Benefits: Life Insurance/AD&D, Short Term Disability and Long-Term disability Basic Life & Accidental Death & Dismemberment (AD&D) Insurance FSA (Commuter/Parking) Employee Assistance Program (EAP) 401(k) Retirement with Company Match Paid Time Off (PTO) and Holidays Tuition Reimbursement Other Compensation Programs: Employee Referral Bonus Resident Referral Bonus Equal Opportunity Statement: Monarch Communities and Brandywine Senior Living is an Equal Opportunity Employer. We comply with all applicable federal, state, and local laws. We celebrate diversity and are committed to creating an inclusive environment for all employees.

A Growing Homecare Company is currently seeking compassionate and experienced Field Nurses to do home visits for our patients in all boroughs of New York. Our goal is to provide superior, compassionate home care workers and healthcare services for elderly and disabled individuals in the comfort and dignity of their homes. We work closely with hospitals, physicians, and private caregivers for hire to develop and coordinate an individual plan of care while maintaining their independence at home. The Field Nurse is responsible for providing professional nursing care to patients requiring in-home care. Responsibilities Assess the patient/family situation for nursing and health-related problems. Educate the patient/family regarding the disease process, self-care techniques, and prevention strategies. Document on a timely basis, all nursing services provided to patients as well as periodic reports to coordinate care and remain in compliance with state/federal regulations. Instruct and supervise patients, caregivers, and home health aides in aspects of patient care as appropriate. Perform other related duties as assigned. Qualifications 1-2 years of experience in Certified Home Health Agency (CHHA) or Long-term care preferred. New York State RN License Strong Assessment and Clinical Skills Bilingual in Mandarin is preferred. Professional Liability Insurance Able to drive an automobile in good working order and available for use in the field. Compensation Initial assessment visit = $130.00 Reassessment visit = $100.00 Resumption of Care visit = $100.00 Supervisory visit = $80.00 **Per Diem and Full-time positions available.

Location: This role enables associates to work virtually full-time, with the exception of required in-person training sessions, providing maximum flexibility and autonomy. This approach promotes productivity, supports work-life integration, and ensures essential face-to-face onboarding and skill development. Please note that per our policy on hybrid/virtual work, candidates not within a reasonable commuting distance from the posting location(s) will not be considered for employment, unless an accommodation is granted as required by law. Hours: Monday - Friday 9:00am to 5:30pm EST and 1-2 late evenings 11:30am to 8:00pm EST. * This position will service members in different states; therefore, Multi-State Licensure will be required. This position requires an on-line pre-employment skills assessment. The assessment is free of charge and can be taken from any PC with Internet access. Candidates who meet the minimum requirements will be contacted via email with instructions. In order to move forward in the process, you must complete the assessment within 48 hours of receipt and meet the criteria. The Telephonic Nurse Case Manager II is responsible for care management within the scope of licensure for members with complex and chronic care needs by assessing, developing, implementing, coordinating, monitoring, and evaluating care plans designed to optimize member health care across the care continuum. Performs duties telephonically. How you will make an impact: * Ensures member access to services appropriate to their health needs. * Conducts assessments to identify individual needs and a specific care management plan to address objectives and goals as identified during assessment. * Implements care plan by facilitating authorizations/referrals as appropriate within benefits structure or through extra-contractual arrangements. * Coordinates internal and external resources to meet identified needs. * Monitors and evaluates effectiveness of the care management plan and modifies as necessary. * Interfaces with Medical Directors and Physician Advisors on the development of care management treatment plans. * Negotiates rates of reimbursement, as applicable. * Assists in problem solving with providers, claims or service issues. * Assists with development of utilization/care management policies and procedures. Minimum Requirements: * Requires BA/BS in a health-related field and minimum of 5 years of clinical experience; or any combination of education and experience, which would provide an equivalent background. * Current, unrestricted RN license in applicable state required. * Multi-state licensure is required if this individual is providing services in multiple states. Preferred Capabilities, Skills and Experiences: * Case Management experience. * Certification as a Case Manager. * Minimum 2 years' experience in acute care setting. * Managed Care experience. * Ability to talk and type at the same time. * Demonstrate critical thinking skills when interacting with members. * Experience with (Microsoft Office) and/or ability to learn new computer programs/systems/software quickly. * Ability to manage, review and respond to emails/instant messages in a timely fashion. For candidates working in person or virtually in the below locations, the salary* range for this specific position is $76,944 to $126,408. Locations: Colorado; New York; New Jersey In addition to your salary, Elevance Health offers benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). The salary offered for this specific position is based on a number of legitimate, non-discriminatory factors set by the Company. The Company is fully committed to ensuring equal pay opportunities for equal work regardless of gender, race, or any other category protected by federal, state, and local pay equity laws. * The salary range is the range Elevance Health in good faith believes is the range of possible compensation for this role at the time of this posting. This range may be modified in the future and actual compensation may vary from posting based on geographic location, work experience, education and/or skill level. Even within the range, the actual compensation will vary depending on the above factors as well as market/business considerations. No amount is considered to be wages or compensation until such amount is earned, vested, and determinable under the terms and conditions of the applicable policies and plans. The amount and availability of any bonus, commission, benefits, or any other form of compensation and benefits that are allocable to a particular employee remains in the Company's sole discretion unless and until paid and may be modified at the Company's sole discretion, consistent with the law. Job Level: Non-Management Exempt Workshift: Job Family: MED > Licensed Nurse Please be advised that Elevance Health only accepts resumes for compensation from agencies that have a signed agreement with Elevance Health. Any unsolicited resumes, including those submitted to hiring managers, are deemed to be the property of Elevance Health. Who We Are 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. How We Work At Elevance Health, we are creating a culture that is designed to advance our strategy but will also lead to personal and professional growth for our associates. Our values and behaviors are the root of our culture. They are how we achieve our strategy, power our business outcomes and drive our shared success - for our consumers, our associates, our communities and our business. We offer a range of market-competitive total rewards that include merit increases, paid holidays, Paid Time Off, and incentive bonus programs (unless covered by a collective bargaining agreement), medical, dental, vision, short and long term disability benefits, 401(k) +match, stock purchase plan, life insurance, wellness programs and financial education resources, to name a few. Elevance Health operates in a Hybrid Workforce Strategy. Unless specified as primarily virtual by the hiring manager, associates 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. The health of our associates and communities is a top priority for Elevance Health. We require all new candidates in certain patient/member-facing roles to become vaccinated against COVID-19 and Influenza. If you are not vaccinated, your offer will be rescinded unless you provide an acceptable explanation. Elevance Health will also follow all relevant federal, state and local laws. Elevance Health is an Equal Employment Opportunity employer, and all qualified applicants will receive consideration for employment without regard to age, citizenship status, color, creed, disability, ethnicity, genetic information, gender (including gender identity and gender expression), marital status, national origin, race, religion, sex, sexual orientation, veteran status or any other status or condition protected by applicable federal, state, or local laws. Applicants who require accommodation to participate in the job application process may contact ******************************************** for assistance. Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state, and local laws, including, but not limited to, the Los Angeles County Fair Chance Ordinance and the California Fair Chance Act.