Nurse Case Manager I

4 weeks ago


Reno, Nevada, United States Elevance Health Full time

Job Summary:

The Nurse Case Manager is responsible for performing care management within the scope of licensure for members with complex and chronic care needs. This includes assessing, developing, implementing, coordinating, monitoring, and evaluating care plans designed to optimize member health care across the care continuum.

Key Responsibilities:

  • 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.

Requirements:

  • Requires BA/BS in a health related field and minimum of 3 years of clinical experience; or any combination of education and experience, which would provide an equivalent background.
  • Current, unrestricted RN license in the state of Nevada required.

Preferred Qualifications:

  • Certification as a Case Manager is preferred.

Additional Information:

Elevance Health is a health company dedicated to improving lives and communities. We offer a range of market-competitive total rewards, including merit increases, paid holidays, Paid Time Off, and incentive bonus programs. We operate in a Hybrid Workforce Strategy, with associates required to work at an Elevance Health location at least once per week. Candidates must reside within 50 miles or 1-hour commute each way of a relevant Elevance Health location.


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