Nurse Case Manager I
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Job Description
Telephonic Nurse Case Manager coordinating assessments, authorizations, and care plans for complex members. Elevance Health delivers healthcare services and support to improve lives and communities.
Responsibilities:
- Provide telephonic care management for members with complex and chronic care needs within the scope of licensure
- Assess members and develop specific 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 plan effectiveness and modify plans as necessary
- Ensure member access to services appropriate to their health needs
- Interface with Medical Directors and Physician Advisors on care management treatment plans
- Assist with provider, claims, or service-related problem solving
- Assist with developing utilization and care management policies and procedures
- Service members in different states
Requirements:
- Requires a BA/BS in a health-related field
- 3 years of clinical experience; or any combination of education and experience, which would provide an equivalent background
- Current, unrestricted RN license from the State of Georgia required
- Multistate licensure is required if providing services in multiple states
- Ability to talk and type at the same time
- Certification as a Case Manager
- Demonstrate critical thinking skills when interacting with members
- Experience with Microsoft Office and/or ability to learn new computer programs/systems/software quickly
- Ability to manage, review and respond to emails/instant messages in a timely fashion
- Must reside in the State of Georgia
- Must complete the online pre-employment skills assessment within 48 hours of receipt and meet the criteria
- Monday–Friday availability, 11:00am–7:30pm, with one 8:30am–5:00pm EST shift per week
Benefits:
- 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 full-time work with flexibility and autonomy
- Required in-person training sessions
- Accommodation for qualifying candidates as required by law
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