FREE ACCESS
5,000–10,000 jobs/day
See all jobs on Scoutfield
Search thousands of fresh jobs every day.
Discover
- Fresh listings
- Fast filters
- No subscription required
Create a free account and start exploring right away.
Telephonic RN 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. Proficient in clinical case management, utilization review, and effective communication with healthcare providers.
Highest-signal resume keywords
RN LicenseClinical Case ManagementUtilization ReviewCare Plan DevelopmentCritical Thinking
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 ManagementAssessmentCare Plan ImplementationDischarge PlanningCoordination of ServicesMonitoring and EvaluationProblem SolvingUtilization ManagementTelephonic CommunicationMicrosoft Office
Soft Skills
CollaborationCommunicationTeamworkCritical ThinkingTime Management
Certifications & Qualifications
RN LicenseMulti-State Licensure
Industry Keywords
Chronic Care ManagementHealthcarePatient CareAuthorizationReferral Management
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, including at hospitals for discharge planning
- Ensure member access to services appropriate to health needs
- Conduct assessments and identify individual care management needs, 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 management plan effectiveness and modify plans as necessary
- Interface with Medical Directors and Physician Advisors on care management treatment plans
- Assist in problem solving with providers
- Assist with development of utilization/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, 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
- Previous experience with utilization review and/or prior authorization
- Clinical case management experience in an inpatient or outpatient setting
- Ability to talk, type and critically think at the same time
- Critical thinking skills when interacting with members
- 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
- Excellent collaboration, communication and teamwork skills
- Ability to work Monday through Friday, 8 am to 5 pm local time
- Vaccination against COVID-19 and Influenza for certain patient/member-facing roles, unless an acceptable explanation is provided
- Must be within a reasonable commuting distance from the posting location(s), unless an accommodation is granted as required by law
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
- Work-life integration
- Accommodation support as required by law