Nurse Case Manager II

Location

United States

Posted

4 days ago

Salary

$79.5K - $124.9K / year

Seniority

Lead

No structured requirement data.

Job Description

Nurse Case Manager II

Elevance Health

Role Description Telephonic Nurse Case Manager II Sign on Bonus: $3000 Location: Virtual - This role enables associates to work virtually full-time, with the exception of required in-person training sessions, providing maximum flexibility and autonomy. This approach promotes productivity, supports work-life integration, and ensures essential face-to-face onboarding and skill development. Alternate locations may be considered if candidates reside within a commuting distance from an office. Please note that per our policy on hybrid/virtual work, candidates not within a reasonable commuting distance from the posting location(s) will not be considered for employment, unless an accommodation is granted as required by law. Hours: Monday - Friday 10:30 AM - 7 PM CST. *****This position will service members in different states; therefore, Multi-State Licensure will be required. The Telephonic Nurse Case Manager II is responsible for care management within the scope of licensure for members with complex and chronic care needs by: - Assessing, developing, implementing, coordinating, monitoring, and evaluating care plans designed to optimize member health care across the care continuum. - Performing duties telephonically or on-site such as at hospitals for discharge planning. How you will make an impact: - Ensures member access to services appropriate to their health needs. - Conducts assessments to identify individual needs and a specific care management plan to address objectives and goals as identified during assessment. - Implements care plan by facilitating authorizations/referrals as appropriate within benefits structure or through extra-contractual arrangements. - Coordinates internal and external resources to meet identified needs. - Monitors and evaluates effectiveness of the care management plan and modifies as necessary. - Interfaces with Medical Directors and Physician Advisors on the development of care management treatment plans. - Negotiates rates of reimbursement, as applicable. - Assists in problem solving with providers, claims or service issues. - Assists with development of utilization/care management policies and procedures. Qualifications - Requires 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 this individual is providing services in multiple states. Requirements - Certification as a Case Manager is preferred. - BS in a health or human services related field is preferred. Benefits - Comprehensive benefits package. - Incentive and recognition programs. - Equity stock purchase. - 401k contribution (all benefits are subject to eligibility requirements).

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