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Nurse Case Manager I
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 the development and coordination of care plans. Holds a current RN license and possesses strong problem-solving skills in clinical settings.
Highest-signal resume keywords
RN LicenseCare ManagementClinical ExperienceCase Management CertificationOncology 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 Plan DevelopmentHealthcare OptimizationAuthorization FacilitationReimbursement NegotiationDischarge Planning
Soft Skills
Problem-SolvingCoordinationCommunication
Certifications & Qualifications
Case Management Certification
Industry Keywords
Chronic CareComplex CareMulti-State LicensureHealth-Related FieldHealth Services
About the role
Key responsibilities & impact- Perform care management within the scope of licensure for members with complex and chronic care needs
- Assess members and 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
- Facilitate authorizations and referrals within the benefits structure or through extra-contractual arrangements
- Coordinate internal and external resources to meet identified needs
- Interface with Medical Directors and Physician Advisors on care management treatment plans
- Negotiate reimbursement rates, as applicable
- Assist with provider, claims, or service issue problem-solving
- Perform duties telephonically or on-site, including 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 providing an equivalent background
- Current, unrestricted and active RN license in applicable state(s)
- Multi-state licensure required when providing services in multiple states
- Certification as a Case Manager preferred
- BS in a health or human services-related field preferred
- Oncology experience preferred
- Must reside within a reasonable commuting distance from the posting location(s), unless accommodation is granted as required by law
- Monday–Friday, 9:00am–5:00pm CST availability
Benefits
Comp & perks- $3000 sign-on bonus
- 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 for required in-person training sessions
- Accommodation for candidates as required by law
- COVID-19 and Influenza vaccination requirements for certain patient/member-facing roles