Business Control Manager – Client Protection
Bank of America
Senior Telephonic Nurse Case Manager
Elevance Health
full-time
Posted on:
Location Type: Hybrid
Location: Atlanta • Maryland, Montana, New Jersey, Wisconsin • 🇺🇸 United States
Visit company websiteSalary
💰 $81,816 - $134,412 per year
Job Level
Senior
About the role
- Responsible for care management within the scope of licensure for members with complex and chronic care needs
- Assess, develop, implement, coordinate, monitor, and evaluate care plans designed to optimize member health care across the care continuum
- Conduct assessments to identify individual needs and a specific care management plan
- Implement care plan by facilitating authorizations/referrals as appropriate
- Coordinate internal and external resources to meet identified needs
- Monitor and evaluate effectiveness of the care management plan
- Interface with Medical Directors and Physician Advisors on the development of care management treatment plans
- Negotiate rates of reimbursement, as applicable
- Assist in problem solving with providers, claims or service issues
- Participate in department audit activities
Requirements
- Requires BA/BS in a health related field
- minimum of 5 years of clinical experience
- Current, unrestricted RN license in applicable state(s) required
- Certification as a Case Manager preferred
- Ability to talk and type at the same time preferred
- Demonstrate critical thinking skills when interacting with members preferred
- Experience with Microsoft Office and/or ability to learn new computer programs/systems/software quickly preferred
- Minimum 2 years’ experience in acute care setting preferred
- Minimum 2 years’ telephonic Case Management experience with a Managed Care Company preferred
- Managed Care experience preferred.
Benefits
- comprehensive benefits package
- incentive and recognition programs
- equity stock purchase
- 401k contribution
- Paid Time Off
- paid holidays
- medical benefits
- dental benefits
- vision benefits
- short and long term disability benefits
Applicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard skills
care managementclinical experiencecare plan developmentassessmentmonitoring and evaluationnegotiationproblem solvingtelephonic case managementmanaged care experience
Soft skills
critical thinkingcommunication
Certifications
RN licenseCase Manager certification
