Market Manager – On Premise
Pernod Ricard
Nurse Case Manager I
Elevance Health
full-time
Posted on:
Location: Kentucky, Missouri, Tennessee • 🇺🇸 United States
Visit company websiteJob Level
Mid-LevelSenior
About the role
- Perform care management within scope of licensure for members with complex and chronic care needs
- Assess, develop, implement, coordinate, monitor, and evaluate individualized care plans
- Conduct telephonic discharge planning
- Facilitate authorizations/referrals within benefits structure or via extra-contractual arrangements
- Coordinate internal and external resources to meet identified member needs
- Monitor and evaluate effectiveness of care management plans and modify as necessary
- Interface with Medical Directors and Physician Advisors on care management treatment plans
- Negotiate rates of reimbursement, as applicable
- Assist in problem solving with providers, claims, or service issues
- Work virtually full-time with required in-person training sessions; participate in onboarding and skill development
Requirements
- Requires BA/BS in a health related field or equivalent combination of education and experience
- Minimum of 3 years of clinical experience
- Current, unrestricted RN license in applicable state(s)
- Multi-state licensure required if providing services in multiple states
- Hospital experience is highly preferred
- Ability to perform telephonic discharge planning
- Must be within reasonable commuting distance to the posting location(s) or have a lawful accommodation
- Must comply with vaccination requirements for certain patient/member-facing roles (COVID-19 and Influenza)
- Work schedule: Monday - Friday 10:30a - 7p CST
