Manager I Care Management
Location: San Juan, Puerto Rico.
Hybrid 2: This role requires associates to be in-office 3 days per week, fostering collaboration and connectivity, while providing flexibility to support productivity and work-life balance. This approach combines structured office engagement with the autonomy of virtual work, promoting a dynamic and adaptable workplace. This position will be based on: 1001 San Roberto St, Ste 101, 401 & 501, San Juan, PR.
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.
Schedule: This position will work 8-hour shifts Monday through Friday and must be available to work within the operational hours of 8:00 a.m. to 6:00 p.m. (AST). Additional hours, including weekends or holidays, may be required based on operational needs.
Axium Healthcare Puerto Rico, a Carelon company, is a clinical pharmacy that offers highly individualized and comprehensive total life care programs to patients and their families. Serving Puerto Rico since 2007, the organization blends a high-touch, caring patient experience with specialized clinical knowledge, personalized care programs, and administrative expertise.
The Manager I Care Management is responsible for managing a team of clinicians charged with promoting quality member outcomes, to optimize member benefits, and to promote effective use of resources.
How you will make an impact:
Primary duties may include, but are not limited to:
- Assesses the medical necessity of outpatient services, out of network services, and appropriateness of treatment setting and level of care.
- Oversees process improvement, quality assurance, and adherence to applicable medical policy, care management best practices, relevant clinical standards, and member contract.
- Ensures prevention and health management program accreditation standards are achieved.
- Participates in establishing strategic plans and objectives; aligning, developing, and implementing functional area policies and procedures to support strategic plans and objectives.
- Participates in establishing and managing the annual budget productivity targets.
- Hires, trains, coaches, counsels, and evaluates performance of direct reports.
Minimum Requirements:
- Requires BS in Nursing and minimum of 5 years of acute care clinical experience; or any combination of education and experience, which would provide an equivalent background.
- Current unrestricted RN license in applicable state(s) required.
Preferred Skills, Capabilities, and Experiences:
- Fully Bilingual (English & Spanish), Must be able to write, read and speak both languages in a proficiency level.
- Certification as a Case Manager preferred.
- Additional schooling or certifications preferred.
For URAC accredited areas, the following applies: Current and active RN license required in applicable state(s) that allows for an independent assessment to be conducted within their scope of practice. Managers who have directly supervised the case management process for 3 or more years are expected to hold a certification as a case manager and meet continuing education requirements to maintain licensure and certification. Requires minimum of 3 years full-time equivalent of direct clinical care experience to the consumer, and minimum of 5 years full-time equivalent of direct clinical care experience to the consumer preferred, or any combination of education and experience, which would provide an equivalent background. Certification as a Case Manager and a BS in a health or human services related field preferred. For URAC accredited areas, the following professional competencies apply: Associates in this role are expected to have strong oral, written and interpersonal communication skills, problem-solving skills, facilitation skills, and analytical skills.
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 should submit the Accessibility Accommodation Request Form and a member of the team will be in contact.
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.
