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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 managing care for members with complex and chronic needs, including assessment, development, and coordination of care plans. Proficient in interfacing with medical professionals and negotiating reimbursement rates while ensuring compliance with health regulations.
Highest-signal resume keywords
RN LicenseCase Management CertificationCare Plan DevelopmentClinical ExperienceUtilization 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 ManagementAssessmentCare CoordinationDischarge PlanningMonitoring Care PlansNegotiationProblem SolvingPolicy DevelopmentReferral FacilitationResource Coordination
Soft Skills
CommunicationInterpersonal SkillsOrganizational SkillsCollaborationCritical Thinking
Certifications & Qualifications
Case Manager Certification
Industry Keywords
Chronic Care ManagementHealth ServicesUtilization ManagementMulti-State LicensurePatient Care
About the role
Key responsibilities & impact- Manage care for members with complex and chronic care needs within the scope of licensure
- Assess, develop, implement, coordinate, monitor, and evaluate care plans across the care continuum
- Perform duties telephonically or on-site, such as at hospitals for discharge planning
- 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 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- 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 this individual is providing services in multiple states
- Certification as a Case Manager is preferred
- Experience as a Case Manager preferred
- BS in a health related field is preferred
- Candidates must reside within a reasonable commuting distance from the posting location(s), unless an 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- comprehensive benefits package
- incentive and recognition programs
- equity stock purchase
- 401k contribution
- merit increases
- paid holidays
- Paid Time Off
- incentive bonus programs
- medical, dental, vision, short and long term disability benefits
- 401(k) +match
- stock purchase plan
- life insurance
- wellness programs
- financial education resources