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Nurse Case Manager – 100% Virtual
Elevance Health. Perform care management within the scope of licensure for members with complex and chronic care needs .
Core Competencies
Role fitCore Competencies
Use this summary to align your resume positioning with the role.
Demonstrates expertise in care management for members with complex and chronic care needs, including assessment, development, and coordination of care plans. Holds a current RN license and possesses strong case management and home health experience.
Highest-signal resume keywords
RN LicenseCase Management CertificationClinical ExperienceCare Plan DevelopmentHome Health Experience
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 ManagementAssessmentCare Plan CoordinationMonitoring Care EffectivenessNegotiating Reimbursement RatesFacilitating AuthorizationsDischarge PlanningIdentifying Care Management ObjectivesEvaluating Care PlansCoordinating Resources
Soft Skills
Interpersonal CommunicationProblem SolvingCollaborationNegotiation
Certifications & Qualifications
Case Manager Certification
Industry Keywords
Chronic Care ManagementHealthcare OptimizationMulti-State LicensurePatient CareCOVID-19 Vaccination Requirement
About the role
Key responsibilities & impact- Perform care management within the scope of licensure for members with complex and chronic care needs
- Assess, develop, implement, coordinate, monitor, and evaluate care plans
- Optimize member healthcare across the care continuum
- Ensure member access to services appropriate to their health needs
- Conduct assessments to identify individual needs and care management objectives and goals
- Facilitate authorizations and referrals within the benefits structure or through extra-contractual arrangements
- Coordinate internal and external resources to meet identified needs
- Monitor and evaluate care plan effectiveness and modify plans as necessary
- Interface with Medical Directors and Physician Advisors on care management treatment plans
- Negotiate reimbursement rates, as applicable
- Assist with provider, claims, or service issues
- Perform duties telephonically or on-site, such as at hospitals for discharge planning
Requirements
What you’ll need- BA/BS in a health related field and minimum of 3 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 providing services in multiple states
- Certification as a Case Manager is preferred
- Prior case management experience is strongly preferred
- Home health experience is strongly preferred
- Monday–Friday availability from 11am–8pm CST
- Candidates must reside within a reasonable commuting distance from the posting location(s), unless an accommodation is granted as required by law
- New candidates in certain patient/member-facing roles must become vaccinated against COVID-19 and Influenza; acceptable explanation required if not vaccinated
Benefits
Comp & perks- Merit increases
- Paid holidays
- Paid Time Off
- Incentive bonus programs (unless covered by a collective bargaining agreement)
- 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 arrangement, except for required in-person training sessions
- Flexible work-life integration and autonomy