Nurse Case Manager II
Elevance Health
Telephonic Nurse Case Manager Senior
Elevance Health
full-time
Posted on:
Origin: • 🇺🇸 United States • Colorado, Missouri
Visit company websiteSalary
💰 $85,712 - $128,568 per year
Job Level
Senior
About the role
- The Telephonic Nurse Case Manager Senior is responsible for care management within the scope of licensure for members with complex and chronic care needs by assessing, developing, implementing, coordinating, monitoring, and evaluating care plans designed to optimize member health care across the care continuum.
- Performs duties telephonically or on-site such as at hospitals for discharge planning.
- 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 to address objectives and goals as identified during assessment.
- Implements care plan by facilitating authorizations/referrals as appropriate within benefits structure or through extra-contractual arrangements.
- 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, chairs and schedules meetings, as well as presents cases for discussion at Grand Rounds/Care Conferences and participates in interdepartmental and/or cross brand workgroups.
- May require the development of a focused skill set including comprehensive knowledge of specific disease process or traumatic injury and functions as preceptor for new care management staff.
- Participates in department audit activities.
Requirements
- Requires BA/BS in a health related field and minimum of 5 years of clinical experience; or any combination of education and experience, which would provide an equivalent background.
- Current, unrestricted RN license in applicable state(s) required.
- Multi-state licensure is required if this individual is providing services in multiple states.
- For URAC accredited areas the following applies: Requires a BA/BS and 5 years of clinical care experience; or any combination of education and experience, which would provide an equivalent background.
- 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.
- 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.
