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Nurse Case Mgr 2
2 months ago
Telephonic Nurse Case Manager II
Sign-on Bonus: $3000
Elevance Health supports a hybrid workplace model with pulse point sites (major offices) used for collaboration, community, and connection. This is a virtual position, but you must reside within 50 miles of an Elevance Health Pulse Point.
Work Location: St. Louis, MO.
Work Schedule: Monday-Friday Hours: 8:30-5:00 pm CST.
The Telephonic Telephonic Nurse Case Manager II is responsible for care management within the scope of licensure for members with complex and chronic care needs by assessing, developing, implementing, coordinating, monitoring, and evaluating care plans designed to optimize member health care across the care continuum. Performs duties telephonically or on-site such as at hospitals for discharge planning.
How you will make an impact:
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Ensures member access to services appropriate to their health needs.
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Conducts assessments to identify individual needs and a specific care management plan to address objectives and goals as identified during the assessment.
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Implements care plan by facilitating authorizations/referrals as appropriate within the benefits structure or through extra-contractual arrangements.
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Coordinates internal and external resources to meet identified needs.
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Monitors and evaluates the effectiveness of the care management plan and modifies it as necessary.
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Interfaces with Medical Directors and Physician Advisors on the development of care management treatment plans.
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Negotiates rates of reimbursement, as applicable.
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Assists in problem solving with providers, claims, or service issues.
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Assists with the development of utilization/care management policies and procedures.
Minimum Requirements:
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Requires BA/BS in a health-related field and a minimum of 5 years of clinical experience; or any combination of education and experience, which would provide an equivalent background.
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Current, unrestricted RN license in applicable state(s) required.
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Multi-state licensure is required if this individual is providing services in multiple states.
Preferred Capabilities, Skills, and Experiences:
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Certification as a Case Manager is preferred.
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BS in a health or human services-related field preferred.
