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Nurse Case Manager
Elevance HealthNurse Case Manager I processing complex care needs as part of Elevance Health's remote care management team. Assessing and coordinating care plans for clients' health needs in a virtual environment.
About the role
Key responsibilities & impact- performing care management within the scope of licensure for members with complex and chronic care needs
- assessing, developing, implementing, coordinating, monitoring, and evaluating care plans designed to optimize member health care across the care continuum
- conducting assessments to identify individual needs and a specific care management plan to address objectives and goals as identified during assessment
- implementing care plan by facilitating authorizations/referrals as appropriate within benefits structure or through extra-contractual arrangements
- coordinating internal and external resources to meet identified needs
- monitoring and evaluating effectiveness of the care management plan and modifying as necessary
- interfacing with Medical Directors and Physician Advisors on the development of care management treatment plans
- negotiating rates of reimbursement, as applicable
- assisting in problem solving with providers, claims or service issues
Requirements
What you’ll need- 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 preferred
- 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
Comp & perks- 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
ATS Keywords
✓ Tailor your resumeApplicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills & Tools
care managementassessingdeveloping care plansimplementing care planscoordinating resourcesmonitoring care plansevaluating care plansnegotiating reimbursement ratesproblem solvingworking with chronic conditions
Soft Skills
interpersonal skillscommunication skillsorganizational skillscollaborationnegotiation skillsadaptabilitycritical thinkingempathyleadershipconflict resolution
Certifications
RN licenseCase Manager certification