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Nurse Case Manager II
2 months ago
We are seeking a skilled Nurse Case Manager II to join our team at Elevance Health. As a key member of our care management team, you will be responsible for providing high-quality care to our members with complex and chronic care needs.
Key Responsibilities- Assess, develop, implement, coordinate, monitor, and evaluate care plans to optimize member health care across the care continuum.
- Conduct thorough assessments to identify individual needs and develop specific care management plans to address objectives and goals.
- Implement care plans by facilitating authorizations/referrals as appropriate within benefits structure or through extra-contractual arrangements.
- Coordinate internal and external resources to meet identified needs.
- Monitor and evaluate the effectiveness of care management plans and modify as necessary.
- Interface with Medical Directors and Physician Advisors on the development of care management treatment plans.
- Assist in problem-solving with providers, claims, or service issues.
- Assist with the development of utilization/care management policies and procedures.
- Requires a BA/BS in a health-related field and a minimum of 5 years of clinical experience; or any combination of education and experience that would provide an equivalent background.
- Current, unrestricted RN license in applicable state(s) required.
- Multi-state licensure is required if this individual is providing services in multiple states.
- Certification as a Case Manager is preferred.
- Telephonic Case Management experience preferred.
Elevance Health is an Equal Employment Opportunity employer and all qualified applicants will receive consideration for employment without regard to age, citizenship status, color, creed, disability, ethnicity, genetic information, gender (including gender identity and gender expression), marital status, national origin, race, religion, sex, sexual orientation, veteran status, or any other status or condition protected by applicable federal, state, or local laws.
