Nurse Case Manager I
24 hours ago
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.
- 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.
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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