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Nurse Case Manager II
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 complex and chronic care needs, including assessment, development, and coordination of care plans. Holds a current RN license and possesses strong problem-solving skills in healthcare settings.
Highest-signal resume keywords
Care ManagementClinical ExperienceRN LicenseCase Management CertificationCare Plan Development
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 AssessmentCare CoordinationDischarge PlanningUtilization ManagementReimbursement Negotiation
Soft Skills
Problem SolvingCommunicationInterpersonal Skills
Certifications & Qualifications
Case Manager Certification
Industry Keywords
Chronic Care ManagementHealth ServicesMulti-State LicensurePatient CareHealthcare Policies
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
- Conduct duties telephonically or on-site, such as at hospitals for discharge planning
- Ensure member access to services appropriate to health needs
- Conduct assessments and create care management plans addressing identified 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 issue problem solving
- Assist with development of utilization/care management policies and procedures
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 state(s) required
- Multi-state licensure is required if providing services in multiple states
- Certification as a Case Manager is preferred
- BS in a health or human services related field preferred
- Ability to work M-F 8am-4:30pm with 2-3 late evenings a month from 11:30am-8pm
- 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- 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 and long term disability benefits
- 401(k) +match
- stock purchase plan
- life insurance
- wellness programs
- financial education resources