Telephonic Nurse Case Manager II

5 days ago


Norfolk, Virginia, United States Elevance Health Full time
Job Summary

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.
Requirements
  • 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.
Preferred Capabilities, Skills and Experiences
  • 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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