Nurse Case Manager II
Elevance Health
full-time
Posted on:
Location Type: Hybrid
Location: Denver • Colorado • Nevada • United States
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Salary
💰 $76,944 - $126,408 per year
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
- Assists with development of utilization/care management policies and procedures
Requirements
- Requires BA/BS in a health related field and minimum of 5 years of clinical experience
- 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
- BS in a health or human services-related field is preferred
- OB experience is strongly preferred
- NICU experience is a plus
Benefits
- Comprehensive benefits package
- Incentive and recognition programs
- Equity stock purchase
- 401k contribution
Applicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills & Tools
care managementclinical assessmentutilization managementnegotiationproblem solvingtreatment planningmonitoring and evaluationreferral managementreimbursement rates
Soft Skills
coordinationcommunicationinterpersonal skillsorganizational skills
Certifications
RN licenseCase Manager certification