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Nurse Case Manager II
Elevance Health. Manage care for members with complex and chronic care needs within the scope of licensure .
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 needs, including assessment, individualized care planning, and coordination of resources. Holds a current RN license and possesses strong problem-solving skills in clinical settings.
Highest-signal resume keywords
RN LicenseCare ManagementClinical ExperienceCase Management CertificationUtilization Management
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 DevelopmentAssessment SkillsAuthorization FacilitationReimbursement NegotiationHospital Discharge Planning
Soft Skills
Problem SolvingCommunicationCoordination
Certifications & Qualifications
Case Manager Certification
Industry Keywords
Chronic Care ManagementHealth Needs AssessmentUtilization PoliciesMulti-State LicensurePatient Care Coordination
About the role
Key responsibilities & impact- Manage care for members with complex and chronic care needs within the scope of licensure
- Assess members and develop individualized care management plans
- Implement care plans by facilitating authorizations and referrals
- Coordinate internal and external resources
- Monitor and evaluate care plan effectiveness and modify plans as needed
- Interface with Medical Directors and Physician Advisors on treatment plans
- Negotiate reimbursement rates as applicable
- Assist with provider, claims, or service-related problem solving
- Assist with development of utilization and care management policies and procedures
- Perform duties telephonically or on-site, including hospital discharge planning
- Ensure member access to services appropriate to their health needs
Requirements
What you’ll need- BA/BS in a health-related field and minimum of 5 years of clinical experience; or any combination of education and experience, which would provide an equivalent background
- Current, unrestricted RN license in applicable home state required
- Multi-state licensure required if providing services in multiple states
- Monday-Friday EST schedule, with one late evening from 11:30am–8:00pm per week
- Certification as a Case Manager is preferred
- Candidates must reside within a reasonable commuting distance from a posting location unless an accommodation is granted
- This position is not eligible for employment-based sponsorship
- New candidates in certain patient/member-facing roles must become vaccinated against COVID-19 and Influenza, unless an acceptable explanation is provided
Benefits
Comp & perks- 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 work flexibility
- Work-life integration
- Required in-person training sessions
- Potential accommodation as required by law