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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, care plan development, and coordination of services. Holds a current RN license and possesses strong case management experience, with a focus on effective communication and problem-solving.
Highest-signal resume keywords
RN LicenseCase Management ExperienceCare Plan DevelopmentClinical ExperienceUtilization Management Policies
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 CoordinationAssessment and EvaluationReimbursement NegotiationProblem-SolvingMonitoring Care Effectiveness
Soft Skills
CommunicationInterpersonal SkillsCollaboration
Certifications & Qualifications
Case Manager CertificationCompact License
Industry Keywords
Chronic Care ManagementHealth Needs AssessmentTelephonic DutiesMulti-State LicensureURAC Accreditation
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, implement, coordinate, monitor, and evaluate care plans
- Ensure member access to services appropriate to health needs
- Conduct assessments to identify individual needs and care management objectives
- Facilitate authorizations and referrals within benefit structures or through extra-contractual arrangements
- Coordinate internal and external resources
- Monitor 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, and service issue problem-solving
- Assist with developing utilization and care management policies and procedures
- Perform duties telephonically
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
- Must reside in EST/CST zones
- Certification as a Case Manager preferred
- Compact license preferred
- Case management experience strongly preferred
- For URAC accredited areas: BA/BS and minimum of 5 years of clinical care experience; or equivalent combination of education and experience
- Current and active RN license required in applicable state(s)
- 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 / 401(k) match
- Merit increases
- Paid holidays
- Paid Time Off
- Incentive bonus programs
- Medical benefits
- Dental benefits
- Vision benefits
- Short-term disability benefits
- Long-term disability benefits
- Stock purchase plan
- Life insurance
- Wellness programs
- Financial education resources
- COVID-19 and Influenza vaccination coverage/requirement for certain roles