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Telephonic Nurse Case Manager II
Elevance Health. Perform telephonic care management 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 telephonic care management, developing and implementing individualized care plans, and coordinating resources to meet complex health needs. Holds a current RN license and possesses extensive experience in case and utilization management within acute care settings.
Highest-signal resume keywords
Telephonic Care ManagementCase Management ExperienceUtilization Management ExperienceCurrent RN LicenseCertification as a Case Manager
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 Management PlansReimbursement NegotiationClinical ExperienceAcute Care ExperiencePolicy Development
Soft Skills
Problem-SolvingEffective CommunicationTimely Email Management
Tools & Technologies
Microsoft OfficeComputer ProgramsSoftware Systems
Certifications & Qualifications
Certification as a Case Manager
Industry Keywords
Chronic Care ManagementHealth-Related FieldMulti-State LicensureCOVID-19 VaccinationInfluenza Vaccination
About the role
Key responsibilities & impact- Perform telephonic care management for members with complex and chronic care needs
- Assess members and develop individualized care management plans
- Implement care plans by facilitating 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 management 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 developing utilization and care management policies and procedures
- Ensure member access to services appropriate to their health needs
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 required
- Multi-state licensure required when providing services in multiple states
- Case Management experience
- Utilization Management experience
- Certification as a Case Manager
- Minimum 2 years’ experience in acute care setting
- Experience with Microsoft Office and/or ability to learn new computer programs, systems, and software quickly
- Ability to manage, review, and respond to emails/instant messages in a timely fashion
- Ability to work Monday–Friday, 10:00am–6:30pm EST, plus 1–2 holidays per year
- Must be within a reasonable commuting distance from the posting location(s), unless an accommodation is granted as required by law
- COVID-19 and Influenza vaccination required for certain patient/member-facing roles, subject to stated exceptions
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) with company match
- Stock purchase plan
- Life insurance
- Wellness programs
- Financial education resources
- Virtual full-time work with required in-person training sessions
- Work-life integration
- Professional growth opportunities