Telephonic Nurse Care Coordinator

2 weeks ago

Denver, Colorado, United States Elevance Health Full time

Position Overview:
This role is designed for a virtual environment, requiring candidates to be located within a specified distance from an Elevance Health Pulse Point.

Work Schedule:

Standard hours are Monday through Friday, from 9:00 AM to 5:30 PM EST, with one late evening shift from 11:30 AM to 8:00 PM EST.

As this position involves servicing members across various states, candidates must possess Multi-State Licensure.

Assessment Requirement:

All candidates must complete an online pre-employment skills assessment, which is complimentary and can be accessed from any computer with internet connectivity. Those who meet the initial qualifications will receive further instructions via email. To proceed, candidates must finish the assessment within 48 hours of receiving it and meet the necessary criteria.


Key Responsibilities:

The Telephonic Nurse Care Coordinator will engage in care management activities within their licensure scope for members facing complex and chronic health challenges. This includes:

  • Ensuring that members have access to services tailored to their health requirements.
  • Conducting thorough assessments to pinpoint individual needs and formulating a specific care management strategy to meet identified objectives.
  • Executing care plans by facilitating necessary authorizations and referrals within the benefits framework or through alternative arrangements.
  • Coordinating both internal and external resources to fulfill identified needs.
  • Monitoring and assessing the effectiveness of care management strategies and making adjustments as required.
  • Collaborating with Medical Directors and Physician Advisors to develop treatment plans.
  • Negotiating reimbursement rates when applicable.
  • Assisting in resolving issues related to providers, claims, or services.

Minimum Qualifications:
  • A Bachelor’s degree in a health-related discipline, combined with 5 years of clinical experience, or an equivalent combination of education and experience.
  • A current, unrestricted RN license in the relevant state(s) is mandatory.
  • Multi-state licensure is essential for those providing services across multiple states.

Preferred Skills and Experience:
  • Certification as a Case Manager is highly regarded.
  • Proficiency in simultaneous verbal communication and typing.
  • Strong critical thinking abilities when interacting with members.
  • Familiarity with Microsoft Office and the ability to quickly adapt to new software.
  • Capability to manage and respond to emails and instant messages promptly.
  • A minimum of 2 years of experience in an acute care setting is preferred.
  • At least 2 years of telephonic Case Management experience within a Managed Care organization is advantageous.
  • Experience in Managed Care is preferred.

Compensation and Benefits:

For candidates working remotely or in person, the salary range for this position is $75,684 to $124,338. Elevance Health also provides a comprehensive benefits package, including incentive programs, equity stock purchase options, and 401k contributions, all subject to eligibility criteria.

The salary offered is based on various legitimate, non-discriminatory factors established by the company.

Elevance Health is committed to ensuring equitable pay opportunities for all employees, regardless of gender, race, or any other protected category under federal, state, and local pay equity laws.


Note:

The salary range reflects Elevance Health's good faith belief regarding the potential compensation for this role at the time of posting. This range may be subject to future adjustments, and actual compensation may vary based on geographic location, work experience, education, and skill level.

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