Telephonic Nurse Case Manager II
5 days ago
Elevance Health is seeking a skilled Telephonic Nurse Case Manager II to join our team. As a Telephonic Nurse Case Manager II, you will be responsible for providing care management services to members with complex and chronic care needs.
Key Responsibilities- Assess, develop, implement, coordinate, monitor, and evaluate care plans to optimize member healthcare across the care continuum.
- 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.
- Requires a BA/BS in a health-related field; 5 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.
- Ability to talk and type at the same time.
- Demonstrate critical thinking skills when interacting with members.
- Experience with Microsoft Office and/or ability to learn new computer programs/systems/software quickly.
- Ability to manage, review and respond to emails/instant messages in a timely fashion.
- Minimum 2 years' experience in acute care setting preferred.
- Minimum 2 years 'telephonic' Case Management experience with a Managed Care Company preferred.
- Managed Care experience preferred.
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