Nurse Care Manager II
3 weeks ago
This is a virtual role requiring a skilled Nurse Care Manager II to provide care management services to members with complex and chronic care needs. The ideal candidate will have a strong background in nursing and experience in care management.
Key Responsibilities:
• Assess, develop, implement, coordinate, monitor, and evaluate care plans to optimize member healthcare across the care continuum.
• Perform duties telephonically, ensuring member access to services appropriate to their health needs.
• 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.
• Assist with development of utilization/care management policies and procedures.
Requirements:
• BA/BS in a health-related field and minimum of 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 Skills:
• Certification as a Case Manager is preferred.
• For URAC accredited areas, requires a BA/BS and minimum of 5 years of clinical care experience; or any combination of education and experience, which would provide an equivalent background.
• Current and active RN license required in applicable state(s). Multi-state licensure is required if this individual is providing services in multiple states. Certification as a Case Manager and a BS in a health or human services-related field preferred.
About Elevance Health
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.
Benefits
We offer a range of market-competitive total rewards that include merit increases, paid holidays, Paid Time Off, and incentive bonus programs (unless covered by a collective bargaining agreement), medical, dental, vision, short and long-term disability benefits, 401(k) + match, stock purchase plan, life insurance, wellness programs, and financial education resources, to name a few.
Equal Employment Opportunity
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.
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