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Telephonic 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 members with complex and chronic needs, utilizing critical thinking and organizational skills to develop and evaluate care plans. Proficient in telephonic case management and familiar with Microsoft 365 tools to enhance communication and coordination.
Highest-signal resume keywords
Current RN LicenseCase Management CertificationTelephonic Case Management ExperienceManaged Care ExperienceClinical Experience in Acute Care
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 ManagementAssessment and EvaluationCare Plan DevelopmentUtilization ManagementTelephonic CommunicationCritical ThinkingMultitaskingOrganizational SkillsMicrosoft 365 ProficiencyEmail Management
Soft Skills
Problem SolvingPrioritizationEffective Communication
Tools & Technologies
Microsoft Office SuiteExcelSharePointTeamsOutlookCopilot
Certifications & Qualifications
Case Management Certification
Industry Keywords
Managed CareCare ContinuumUtilization Management PoliciesChronic Care ManagementHealth Related Field
About the role
Key responsibilities & impact- Provide care management within the scope of licensure for members with complex and chronic care needs
- Assess members and develop, implement, coordinate, monitor, and evaluate care plans across the care continuum
- Perform duties telephonically
- 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
- Assist providers with problem solving
- 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 state(s) required
- Multi-state licensure required if providing services in multiple states
- For URAC accredited areas: BA/BS and minimum of 5 years of clinical care experience; or equivalent combination of education and experience
- Current and active RN license required in applicable state(s)
- Certification as a Case Manager preferred
- Ability to talk and type at the same time preferred
- Critical thinking skills when interacting with members preferred
- Ability to work across multiple applications/screens and multitask effectively preferred
- Strong organizational and prioritization skills preferred
- Proficiency in Microsoft 365/Microsoft Office Suite (Excel, SharePoint, Teams, Outlook) and Copilot preferred
- Ability to learn new systems/software quickly
- Ability to manage, review and respond to emails/instant messages in a timely fashion preferred
- 2 years’ experience in acute care setting preferred
- 2 years’ telephonic Case Management experience with a Managed Care Company preferred
- Managed Care experience preferred
- Ability to complete the online pre-employment skills assessment within 48 hours and meet the criteria
- Availability to work Monday-Friday 9:00am-5:30pm EST and one late evening 11:30am-8:00pm EST
- Compliance with applicable vaccination requirements for certain patient/member-facing roles
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 work flexibility
- Required in-person training sessions
- Accommodation support as required by law