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Telephonic Nurse Case Manager II at Elevance Health
3 months ago
**Location: This is a virtual position. Candidates must reside within 50 miles of an Elevance Health Pulse Point location.**
**Hours:** **Monday - Friday 9:00am to 5:30pm with 1-2 late evenings 11:30am to 8:00pm depending on your time zone.**
- This position will service members in different states; therefore, Multi-State Licensure will be required.**
How You Will Make An 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 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.
Minimum 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 required.
Multi-state licensure is required if this individual is providing services in multiple states.
Preferred Capabilities, Skills And Experiences
Certification as a Case Manager is preferred.
Compact RN license preferred.
Minimum 2 Years' Experience In Acute Care Setting.
Managed Care experience.
Ability to talk and type at the same time.
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.
Compensation Information
$0.0 / - $0.0 /
Starting At: 0.0
Up To: 0.0
