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Nurse Case Manager
1 month ago
Job Summary:
Elevance Health is seeking a skilled Nurse Case Manager to join our team. As a key member of our healthcare team, you will be responsible for providing high-quality care to our members with complex and chronic care needs.
Responsibilities:
- Assess, develop, implement, coordinate, monitor, and evaluate care plans to optimize member health care across the care continuum.
- Perform duties telephonically, ensuring effective communication with members, healthcare providers, and other stakeholders.
- Conduct 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 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.
Preferred Capabilities, Skills, and Experiences:
- Certification as a Case Manager.
Benefits:
- Market-competitive total rewards, including merit increases, paid holidays, Paid Time Off, and incentive bonus programs.
- Comprehensive benefits package, including medical, dental, vision, short and long-term disability benefits, 401(k) + match, stock purchase plan, life insurance, wellness programs, and financial education resources.
Work Environment:
Elevance Health operates in a Hybrid Workforce Strategy. Associates are required to work at an Elevance Health location at least once per week, and potentially several times per week. Specific requirements and expectations for time onsite will be discussed as part of the hiring process.
Candidates must reside within 50 miles or 1-hour commute each way of a relevant Elevance Health location.
The health of our associates and communities is a top priority for Elevance Health. We require all new candidates in certain patient/member-facing roles to become vaccinated against COVID-19. If you are not vaccinated, your offer will be rescinded unless you provide an acceptable explanation.
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.
