Telephonic Nurse Case Manager II
Elevance Health
full-time
Posted on:
Location Type: Hybrid
Location: Iselin • Florida, New Jersey, New York • 🇺🇸 United States
Visit company websiteSalary
💰 $76,944 - $126,408 per year
Job Level
Mid-LevelSenior
About the role
- responsible for care management within the scope of licensure for members with complex and chronic care needs
- assessing, developing, implementing, coordinating, monitoring, and evaluating care plans designed to optimize member health care across the care continuum
- performs duties telephonically
- ensures member access to services appropriate to their health needs
- conducts assessments to identify individual needs and a specific care management plan
- implements care plan by facilitating authorizations/referrals as appropriate
- 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
Requirements
- Requires BA/BS in a health-related field and minimum of 5 years of clinical experience
- Current, unrestricted RN license in applicable state required
- Multi-state licensure is required if providing services in multiple states
- Case Management experience preferred
- Certification as a Case Manager preferred
- Minimum 2 years’ experience in acute care setting preferred
- Managed Care experience preferred
- Ability to talk and type at the same time
- Demonstrates 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.
Benefits
- comprehensive benefits package
- incentive and recognition programs
- equity stock purchase
- 401k contribution
- paid holidays
- Paid Time Off
- wellness programs
- financial education resources
Applicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard skills
care managementclinical experiencecase managementutilization managementacute carenegotiationassessmentcare plan developmentmonitoring and evaluationproblem solving
Soft skills
critical thinkingcommunicationcoordinationinterpersonal skillsorganizational skillstime management
Certifications
RN licenseCase Manager certification