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Nurse Case Manager I
Elevance HealthTelephonic Nurse Case Manager I at Elevance Health managing care for members with complex health needs through assessments and care plans.
About the role
Key responsibilities & impact- 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 Advisor's on the development of care management treatment plans
- Assists in problem solving with providers, claims or service issues
- Assists with development of utilization/care management policies and procedures
Requirements
What you’ll need- Requires a BA/BS in a health-related field
- 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
- Multistate licensure is required if this individual is providing services in multiple states
- Ability to talk and type at the same time
- Certification as a Case Manager
- Demonstrate critical thinking skills when interacting with members
- Experience with (Microsoft Office) and/or ability to learn new computer programs/systems/software quickly
- Ability to manage, review and respond to emails/instant messages in a timely fashion
Benefits
Comp & perks- 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
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
clinical experiencecare managementassessmentsproblem solvingutilization managementtreatment plansauthorizationsreferralscritical thinking
Soft Skills
communicationinterpersonal skillsorganizational skillstime management
Certifications
RN licenseCase Manager certification