Medical Support Operation Manager
The University of Kansas Health System
Telephonic Nurse Case Manager II
Elevance Health
full-time
Posted on:
Location: Colorado, Missouri, Virginia • 🇺🇸 United States
Visit company websiteSalary
💰 $80,608 - $120,912 per year
Job Level
Mid-LevelSenior
About the role
- Telephonic Nurse Case Manager II responsible for care management within scope of licensure for members with complex and chronic care needs
- Assess, develop, implement, coordinate, monitor, and evaluate individualized care plans designed to optimize member health across the care continuum
- Perform duties telephonically and facilitate authorizations/referrals within benefits structure or via extra-contractual arrangements
- Coordinate internal and external resources, monitor and modify care management plans as necessary
- Interface with Medical Directors and Physician Advisors on care management treatment plans and assist in negotiating reimbursement rates
- Assist in problem solving with providers, claims or service issues and contribute to development of utilization/care management policies and procedures
- Work schedule: Monday - Friday 9:00am to 5:30pm EST and one late evening 11:30am to 8:00pm EST
- Role enables associates to work virtually full-time except required in-person training sessions; alternate locations may be considered if within commuting distance
Requirements
- Requires BA/BS in a health related field and minimum of 5 years of clinical experience; or any combination of education and experience
- Current, unrestricted RN license in applicable state(s) required
- Multi-state licensure required if providing services in multiple states
- For URAC accredited areas: BA/BS and minimum of 5 years of clinical care experience 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
- Ability to manage, review and respond to emails/instant messages in a timely fashion 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
- Must complete an on-line pre-employment skills assessment within 48 hours of receipt and meet criteria
