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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 clinical experience to effectively interface with medical professionals and negotiate care management processes.
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 Plan ImplementationDischarge PlanningAuthorization FacilitationReimbursement NegotiationUtilization ManagementPolicy DevelopmentMonitoring Care EffectivenessResource CoordinationObjective Setting
Soft Skills
CommunicationProblem SolvingInterpersonal SkillsNegotiationCollaboration
Certifications & Qualifications
Case Manager Certification
Industry Keywords
Chronic Care ManagementHealth Needs AssessmentMulti-State LicensureCOVID-19 VaccinationInfluenza 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
- Conduct duties telephonically or on-site, including at hospitals for 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 benefits structures 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 development of 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 home state required
- Multi-state licensure required when providing services in multiple states
- Certification as a Case Manager is preferred
- Monday-Friday EST work schedule with one late evening shift, 11:30am–8:00pm, per week
- Must reside within a reasonable commuting distance from the posting location(s), unless an accommodation is granted as required by law
- Position is not eligible for employment-based sponsorship
- COVID-19 and Influenza vaccination required for certain patient/member-facing roles, 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
- Professional growth opportunities