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RN Nurse Case Manager I
Elevance HealthTelephonic RN case manager coordinating complex and chronic care for Elevance Health members. Assessing needs, implementing care plans, and facilitating benefits access and referrals.
Core Competencies
Role fitCore Competencies
Use this summary to align your resume positioning with the role.
Demonstrates expertise in care management for members with complex and chronic needs, including the development and implementation of care plans, coordination of resources, and effective communication with healthcare professionals. Holds a current RN license and possesses strong critical thinking and collaboration skills essential for patient advocacy and service access.
Highest-signal resume keywords
Current RN LicenseClinical Case Management ExperienceUtilization Review ExperienceCare Plan DevelopmentCritical Thinking Skills
ATS Keywords
Tailor your resumeApplicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills
Care ManagementAssessment and EvaluationCare Plan ImplementationDischarge PlanningEducation and Referral Coordination
Soft Skills
CollaborationCommunicationTeamworkCritical Thinking
Tools & Technologies
Microsoft OfficeComputer ProgramsSoftware Systems
Certifications & Qualifications
RN LicenseMulti-State Licensure
Industry Keywords
Chronic Care ManagementUtilization ReviewPrior AuthorizationInpatient CareOutpatient Care
About the role
Key responsibilities & impact- Perform care management within the scope of licensure for members with complex and chronic care needs
- Assess members and develop, implement, coordinate, monitor, and evaluate care plans across the care continuum
- Perform duties telephonically or on-site, including at hospitals for discharge planning
- Ensure members understand benefits and assist them in accessing appropriate services
- Conduct assessments to identify individual needs and care management objectives and goals
- Implement care plans through education, authorizations, referrals, and extra-contractual arrangements as appropriate
- Coordinate internal and external resources to meet identified needs
- Monitor and evaluate care plan effectiveness and modify plans as necessary
- Interface with Medical Directors and other health professionals on treatment plans
- Assist members and providers with access to care, vendors, claims, and service issues
Requirements
What you’ll need- BA/BS in a health-related field and a minimum of 3 years of clinical experience, or an equivalent combination of education and experience
- Current, unrestricted compact RN license in the candidate's home state
- Multi-state licensure if providing services in multiple states
- Previous experience with utilization review and/or prior authorization preferred
- Clinical case management experience in an inpatient or outpatient setting preferred
- Ability to talk, type, and critically think simultaneously
- Demonstrated critical thinking skills when interacting with members
- Experience with Microsoft Office and/or ability to quickly learn new computer programs, systems, and software
- Ability to manage, review, and respond to emails and instant messages in a timely fashion
- Excellent collaboration, communication, and teamwork skills
- Availability Monday through Friday, 8 am to 5 pm local time
Benefits
Comp & perks- Virtual full-time work arrangement with maximum flexibility and autonomy
- Required in-person training sessions supporting face-to-face onboarding and skill development
- Merit increases
- Paid holidays
- Paid Time Off
- Incentive bonus programs
- Medical benefits
- Dental benefits
- Vision benefits
- Short-term disability benefits
- Long-term disability benefits
- 401(k) with company match
- Stock purchase plan
- Life insurance
- Wellness programs
- Financial education resources