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Nurse Case Manager II
Elevance Health. Perform 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, care plan development, and coordination of services. Holds a current RN license and possesses strong negotiation and communication skills to facilitate effective care delivery.
Highest-signal resume keywords
Care ManagementRN LicenseClinical ExperienceCase Management CertificationCare Plan Development
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 AssessmentCare CoordinationHospital Discharge PlanningUtilization ManagementReimbursement Negotiation
Soft Skills
CommunicationProblem SolvingInterpersonal Skills
Certifications & Qualifications
Case Manager Certification
Industry Keywords
Chronic Care ManagementHealth ServicesPatient CareMulti-State LicensureCOVID-19 Vaccination
About the role
Key responsibilities & impact- Perform 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, such as hospital discharge planning
- Ensure member access to services appropriate to health needs
- Conduct assessments and create care management plans addressing identified 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 reimbursement rates, as applicable
- Assist with provider, claims, or service issue resolution
- Assist with developing utilization and 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 is preferred
- BS in a health or human services 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
- Certain patient/member-facing roles require vaccination 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 full-time work flexibility, except for required in-person training sessions