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Lead Nurse Case Manager
Elevance HealthTelephonic Nurse Case Manager Lead responsible for managing care for members with chronic health concerns. Position requires clinical experience and coordination with healthcare providers in various states.
About the role
Key responsibilities & impact- Telephonic Nurse Case Manager Lead
- Responsible for 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.
- Ensures member access to services appropriate to their health needs.
- Performs duties telephonically or on-site such as at hospitals for discharge planning.
- 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.
Requirements
What you’ll need- Requires a BA/BS in a health related field and 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.
- Case manager certification required within 3 years of starting in this role.
- Certification as a Case Manager is preferred.
- BS in a health or human services related field preferred.
- Managed care experience necessary.
- Case management experience a plus.
Benefits
Comp & perks- Sign on Bonus: $3000
- Merit increases
- Paid holidays
- Paid Time Off
- Medical benefits
- Dental benefits
- Vision benefits
- 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 managementassessmentcare plan developmentmonitoringevaluationauthorizationreferral facilitationnegotiationproblem solving
Soft Skills
coordinationcommunicationinterpersonal skills
Certifications
RN licenseCase Manager certification