Nurse Case Manager I
Elevance Health
full-time
Posted on:
Location Type: Hybrid
Location: New Orleans • Louisiana • 🇺🇸 United States
Visit company websiteJob Level
Mid-LevelSenior
About the role
- Responsible for performing 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.
- 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.
Requirements
- Requires BA/BS in a health related field and minimum of 3 years of clinical experience
- Current, unrestricted RN license in applicable state(s) required
- Certification as a Case Manager is preferred
- Experience with working with the homeless and substance use disorders
- Experience with Adult population with Chronic Conditions such as Diabetes, Sickle Cell, Congestive Heart Failure, Hepatitis, HIV, and Hypertension preferred
- Experience in hospital, case management, MCO experience preferred.
- Combination of the following is a plus: Acute care, home health, chronic illnesses/diseases, discharge planning.
- Behavioral health conditions experience preferred
Benefits
- Paid Time Off
- medical, dental, vision benefits
- short and long term disability benefits
- 401(k) +match
- stock purchase plan
- life insurance
- 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 managementassessmentscare plansauthorizationsreferralsnegotiationproblem solvingchronic conditionsdischarge planningbehavioral health
Certifications
RN licenseCase Manager certification