Transplant Nurse II (US)

Anticipated End Date 2026-04-20 Position Title Transplant Nurse II (US) Job Description Transplant Nurse II Location Virtual: 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. Shift This position will include weekends (both Saturday and Sunday) as well as 3 consecutive weekdays. Responsibilities 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. Interfaces with Medical Directors and Physician Advisors on the development of care management treatment plans. Assists in problem solving with providers, claims or service issues. Assists with development of utilization/care management policies and procedures. Within the medical management role, collaborates with healthcare providers and members to promote quality member outcomes, optimize member benefits, and promote effective use of resources for more complex medical transplant issues. 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. Conducts pre‑certification, 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 medically necessary, quality healthcare in a cost-effective setting according to contract. Consults 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 members’ 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. Minimum Requirements Requires AS in nursing and minimum of 3 years of clinical experience; or any combination of education and experience, which would provide an equivalent background. Preferred Skills, Capabilities, and Experiences 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 associates performing medical management. Must be able to be licensed in multiple states in a timely basis. Knowledge of health insurance/benefits strongly preferred. Transplant experience strongly preferred. Job Level Non-Management Exempt Job Family MED > Licensed Nurse Equal Employment Opportunity 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 View email address on click.appcast.io 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. Prospective employees required to be screened under Florida law should review the education and awareness resources at HB531 | Florida Agency for Health Care Administration. #J-18808-Ljbffr Elevance Health