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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 complex and chronic care needs, including assessment, development, and coordination of individualized care plans. Proficient in interfacing with medical professionals and negotiating reimbursement rates while ensuring compliance with health regulations.
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 Plan DevelopmentAssessment SkillsDischarge PlanningCoordination of ServicesMonitoring Care EffectivenessNegotiation SkillsProblem SolvingPolicy Development
Soft Skills
Communication SkillsInterpersonal SkillsOrganizational Skills
Certifications & Qualifications
Case Manager CertificationActive Registered Nurse Compact License
Industry Keywords
Chronic Care ManagementHealth ServicesUtilization ManagementMulti-State LicensureCOVID-19 Vaccination Requirement
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 or on-site, including at hospitals for discharge planning
- Ensure member access to services appropriate to health needs
- Conduct assessments and create individualized care management plans
- 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 providing an equivalent background
- Current, unrestricted RN license in applicable state(s) required
- Multi-state licensure required if providing services in multiple states
- Certification as a Case Manager preferred
- BS in a health or human services related field preferred
- Active Registered Nurse Compact License highly preferred
- Ability to work Monday–Friday scheduled hours
- Candidates must reside within a reasonable commuting distance from the posting location(s), 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- 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-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
- Professional and personal growth opportunities