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Nurse Case Manager II
Elevance Health. Provide care management for members with complex and chronic care needs within 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 the development and implementation of individualized care plans, coordination of resources, and effective communication with medical professionals. Holds a current RN license and possesses strong clinical experience to ensure optimal member access to services.
Highest-signal resume keywords
Care ManagementClinical ExperienceRN LicenseCase 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 Management PlansAssessment SkillsAuthorization ProcessesReimbursement NegotiationHospital Discharge Planning
Soft Skills
Communication SkillsProblem-Solving SkillsInterpersonal Skills
Certifications & Qualifications
Case Manager Certification
Industry Keywords
Chronic Care ManagementHealth Needs AssessmentUtilization PoliciesMulti-State LicensureCOVID-19 Vaccination Requirement
About the role
Key responsibilities & impact- Provide care management for members with complex and chronic care needs within scope of licensure
- Assess members and develop individualized care management plans
- Implement care plans through authorizations and referrals within benefits structures or extra-contractual arrangements
- Coordinate internal and external resources
- Monitor and evaluate care plan effectiveness and modify plans as needed
- Interface with Medical Directors and Physician Advisors on care management treatment plans
- Negotiate reimbursement rates as applicable
- Assist with provider, claims, and service issue resolution
- Assist with development of utilization and care management policies and procedures
- Ensure member access to services appropriate to health needs
- Perform duties telephonically or on-site, including hospital discharge planning
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 providing an equivalent background
- Current, unrestricted RN license in applicable state(s) required
- Multi-state licensure required when providing services in multiple states
- Certification as a Case Manager is preferred
- BS in a health or human services-related field preferred
- Monday-Friday, 10:00 am-6:30 pm EST work schedule
- Candidates must reside within reasonable commuting distance of a posting location unless an accommodation is granted
- 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
- 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
- Virtual work flexibility
- Required in-person training sessions
- Incentive and recognition programs
- Equity stock purchase