Nurse Case Manager I

24 hours ago


Grand Prairie, Texas, United States Elevance Health Full time
Job Summary

Elevance Health is seeking a skilled Nurse Case Manager I to join our team. As a key member of our healthcare team, you will be responsible for providing high-quality care management services to our members with complex and chronic care needs.

Key Responsibilities
  • Assess and develop individualized care plans to optimize member health care across the care continuum.
  • Conduct thorough assessments to identify member 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 member 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.
  • Negotiate rates of reimbursement, as applicable.
  • Assist in problem-solving with providers, claims, or service issues.
Requirements
  • 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 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.
About Elevance Health

Elevance Health is a health company dedicated to improving lives and communities - and making healthcare simpler. We are a Fortune 25 company with a longstanding history in the healthcare industry, looking for leaders at all levels of the organization who are passionate about making an impact on our members and the communities we serve.



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