Telephonic Nurse Case Manager, II
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Job Description
Telephonic Nurse Case Manager coordinating care plans for members with complex and chronic needs. Supporting access, authorizations, referrals, and provider collaboration for Elevance Health.
Responsibilities:
- Provide telephonic care management for members with complex and chronic care needs within scope of licensure
- Assess member needs and develop individualized care management plans
- Implement care plans by facilitating authorizations and referrals within benefits structures 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 treatment plans
- Ensure member access to appropriate health services
- Negotiate reimbursement rates as applicable
- Assist with provider, claims, or service issue problem-solving
- Assist with development of utilization and care management policies and procedures
Requirements:
- 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
- Certification as a Case Manager
- Minimum 2 years’ experience in acute care setting
- Managed Care experience
- Ability to talk and type 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
- Must complete the online pre-employment skills assessment within 48 hours of receipt and meet the criteria
- Must reside within a reasonable commuting distance from the posting location(s), unless an accommodation is granted as required by law
- Ability to work Monday–Friday 9:00am–5:30pm EST and one late evening 11:30am–8:00pm EST
- Multi-State Licensure required to service members in different states
Benefits:
- Comprehensive benefits package
- Incentive and recognition programs
- Equity stock purchase
- 401k contribution
- 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 match
- Stock purchase plan
- Life insurance
- Wellness programs
- Financial education resources
- Virtual work flexibility
- Required in-person training sessions
- COVID-19 and Influenza vaccination support/requirement for certain roles
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