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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 .
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 across the care continuum
- Perform duties telephonically
- Ensure member access to services appropriate to health needs
- Conduct assessments and identify individualized care management plans
- 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
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
- Candidates must reside within a reasonable commuting distance from the posting location(s), unless an accommodation is granted as required by law
- COVID-19 and Influenza vaccination required for certain patient/member-facing roles unless an acceptable explanation is provided
- Monday–Friday availability, 8:00am–4:30pm EST, with 2 evenings per month
Benefits
Comp & perks- Comprehensive benefits package
- Incentive and recognition programs
- Equity stock purchase
- 401k contribution
- 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) with match
- Stock purchase plan
- Life insurance
- Wellness programs
- Financial education resources