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Nurse Case Manager II
Elevance Health. Provide 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 needs, including assessment, development, and coordination of care plans. Holds a current RN license and possesses strong case management and utilization management experience.
Highest-signal resume keywords
Current RN LicenseMulti-State LicensureCase Management ExperienceUtilization Management ExperienceCertification as a Case Manager
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 ManagementAssessmentCare Plan DevelopmentCoordination of ServicesMonitoring and EvaluationNegotiationProblem SolvingUtilization Management
Soft Skills
Timely CommunicationInterpersonal Skills
Tools & Technologies
Microsoft OfficeComputer Programs
Certifications & Qualifications
Certification as a Case Manager
Industry Keywords
Chronic CareAcute Care SettingTelephonic CareAuthorization and ReferralsHealth Needs Assessment
About the role
Key responsibilities & impact- Provide 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 their health needs
- Conduct assessments to identify individual needs and care management 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 management plan effectiveness and modify plans as necessary
- Interface with Medical Directors and Physician Advisors on care management treatment plans
- Negotiate rates of reimbursement, 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- Current, unrestricted RN license in applicable state required
- Multi-state licensure required if providing services in multiple states
- Multi-State Licensure required because the position services members in different states
- Case Management experience
- Utilization Management experience
- Certification as a Case Manager
- Minimum 2 years’ experience in acute care setting
- Experience with Microsoft Office and/or ability to learn new computer programs/systems/software quickly
- Ability to manage, review and respond to emails/instant messages in a timely fashion
- Candidates must reside within commuting distance from an office unless accommodation is granted as required by law
- 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 full-time work, except for required in-person training sessions
- Flexible work-life integration
- COVID-19 and Influenza vaccination support/requirement for certain patient/member-facing roles