Telephonic Nurse Case Manager II
Elevance Health
Nurse Case Manager I
Elevance Health
full-time
Posted on:
Origin: • 🇺🇸 United States
Visit company websiteJob Level
Mid-LevelSenior
About the role
- Location: virtual full-time with required in-person training sessions; Hybrid Workforce Strategy.
- Requires associates to work at an Elevance Health location at least once per week.
- Performs 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 for discharge planning.
- How you will make an impact: 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 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.
Requirements
- Requires BA/BS in a health related field and minimum of 3 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.
- Certification as a Case Manager is preferred.
