Nurse Case Manager II
Elevance Health
full-time
Posted on:
Location Type: Hybrid
Location: St. Louis • Florida • Kentucky • United States
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About the role
- This role enables associates to work virtually full-time, with the exception of required in-person training sessions, providing maximum flexibility and autonomy.
- 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; 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.
- Case Management experience is preferred.
- Minimum 2 years’ experience in acute care setting is preferred.
- Managed Care experience is preferred.
- Ability to talk and type at the same time is preferred.
- Demonstrate critical thinking skills when interacting with members is preferred.
- Experience with Microsoft Office and/or ability to learn new computer programs/systems/software quickly is preferred.
- Ability to manage, review and respond to emails/instant messages in a timely fashion is preferred.
Benefits
- Sign on Bonus: $3000
- Paid Time Off
- Medical benefits
- Dental benefits
- Vision benefits
- Short and long term disability benefits
- 401(k) + match
- Stock purchase plan
- 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
clinical experiencecase managementacute care experiencemanaged care experiencecritical thinking
Soft Skills
problem solvingcommunicationflexibilityautonomytimely response
Certifications
RN licensemulti-state licensure