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Healthcare Case Manager I

2 months ago

Memphis, Tennessee, United States Elevance Health Full time
Position Title: Nurse Case Manager I

Location:
Candidates must reside in the Western Region of Tennessee, ideally within a 50-mile radius of Elevance Health PulsePoint locations.

Work Schedule:
Standard business hours, Monday through Friday.

Role Overview:
The Nurse Case Manager I is tasked with delivering care management services within the professional scope of practice for members facing complex and chronic health challenges. This involves:
  • Assessing individual health needs and formulating tailored care management strategies.
  • Implementing, coordinating, and monitoring care plans aimed at enhancing overall health outcomes.
  • Conducting field visits and telephonic outreach to ensure effective discharge planning and service access.

Key Responsibilities:
  • Facilitating access to necessary services aligned with members' health requirements.
  • Conducting comprehensive assessments to pinpoint specific needs and develop actionable care management plans.
  • Executing care plans by securing authorizations and referrals as needed within the benefits framework.
  • Coordinating resources, both internal and external, to address identified health needs.
  • Monitoring the success of care management initiatives and adjusting plans as required.
  • Collaborating with Medical Directors and Physician Advisors to create effective treatment strategies.
  • Negotiating reimbursement rates when applicable.
  • Assisting in resolving issues related to providers, claims, or services.

Qualifications:
  • A Bachelor’s degree in a health-related discipline and a minimum of three 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 necessary for services across multiple states.

Preferred Qualifications:
  • Certification as a Case Manager is highly desirable.
  • A Bachelor’s degree in a health or human services-related field alongside Case Manager certification is preferred.