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Telephonic Nurse Case Manager I
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 case management skills, with a focus on multi-state service delivery.
Highest-signal resume keywords
RN LicenseCase Management ExperienceClinical ExperienceMulti-State LicensureOncology Experience
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 and EvaluationCare CoordinationAuthorization FacilitationReimbursement Negotiation
Soft Skills
Interpersonal CommunicationProblem SolvingNegotiation
Certifications & Qualifications
Case Manager Certification
Industry Keywords
Chronic Care ManagementHealth Needs AssessmentTelephonic ServicesProvider RelationsCOVID-19 Vaccination Requirement
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
- Ensure member access to services appropriate to health needs
- Conduct assessments and identify individual needs and care management objectives
- Facilitate authorizations and referrals within benefits structures or through extra-contractual arrangements
- Coordinate internal and external resources
- Monitor and modify care management plans as necessary
- Interface with Medical Directors and Physician Advisors on treatment plans
- Negotiate reimbursement rates as applicable
- Assist with provider, claims, or service issues
- Perform duties telephonically
- Service members in different states
Requirements
What you’ll need- BA/BS in a health related field and minimum of 3 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 providing services in multiple states
- Certification as a Case Manager is preferred
- Oncology experience a plus
- Case Management experience preferred
- Candidates must reside within a reasonable commuting distance from the posting location(s), unless an accommodation is granted
- Required to become vaccinated against COVID-19 and Influenza for certain patient/member-facing roles
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