Nurse Case Manager I
Elevance Health
full-time
Posted on:
Location Type: Hybrid
Location: Altamonte Springs • Florida • 🇺🇸 United States
Visit company websiteJob Level
Mid-LevelSenior
About the role
- 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.
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.
- Spanish speaking bilingual strongly preferred.
- 2+ years of experience with the pediatric population strongly preferred.
- Certification as a Case Manager is preferred.
Benefits
- merit increases
- paid holidays
- Paid Time Off
- incentive bonus programs
- medical
- dental
- vision
- 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
clinical experiencecare managementassessmentscare plan implementationnegotiationproblem solving
Soft skills
coordinationcommunicationevaluationinterpersonal skills
Certifications
RN licenseCase Manager certification