Nurse Case Manager I
Elevance Health
full-time
Posted on:
Location Type: Hybrid
Location: Grand Prairie • Kansas • Louisiana • United States
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About the role
- 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.
- Performs duties telephonically such as at hospitals for discharge planning.
- Ensures member access to services appropriate to their health needs.
- Conducts assessments to identify individual needs and family’s 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.
- Experience in Obstetrics and Pediatrics nursing or Maternal Child and Women's Health is strongly preferred.
- Managed Care Organization (MCO) experience is preferred.
- Certification as a Case Manager is preferred.
Benefits
- merit increases
- paid holidays
- Paid Time Off
- incentive bonus programs (unless covered by a collective bargaining agreement)
- 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 & Tools
care managementassessmentscare plansdischarge planningauthorizationsreferralsmonitoringevaluatingnegotiating reimbursementproblem solving
Certifications
RN licenseCase Manager certification