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Telephonic Nurse Care Manager II
2 months ago
Overview:
As a Telephonic Nurse Care Manager II, you will play a crucial role in managing the care of members with complex and chronic health conditions. This position is part of Elevance Health, a leader in the healthcare industry dedicated to enhancing access to care and improving health outcomes for our communities.
Location:
This role is virtual, but candidates must reside within a specified distance of an Elevance Health location.
Work Schedule:
Standard hours are Monday to Friday, from 10 am to 6:30 pm EST.
Key Responsibilities:
- Facilitate member access to necessary services tailored to their health requirements.
- Conduct comprehensive assessments to determine individual needs and develop targeted care management plans.
- Implement care strategies by coordinating authorizations and referrals within the established benefits framework.
- Collaborate with both internal and external resources to address identified member needs.
- Continuously monitor and assess the effectiveness of care management plans, making adjustments as needed.
- Engage with Medical Directors and Physician Advisors to create effective treatment plans.
- Assist in resolving issues related to providers, claims, or service delivery.
- Contribute to the formulation of utilization and care management policies.
Qualifications:
- A Bachelor’s degree in a health-related field is required, along with a minimum of five years of clinical experience.
- A current, unrestricted RN license in the applicable state(s) is mandatory.
- Multi-state licensure is necessary for those providing services across state lines.
Preferred Qualifications:
- Certification as a Case Manager is highly desirable.
- A Bachelor’s degree in a health or human services-related discipline is preferred.
- Experience in obstetrics (OB) is strongly preferred, with NICU experience considered a plus.
- Excellent communication, problem-solving, and analytical skills are essential.
- Familiarity with medical management processes and the ability to interpret member contracts and benefits is preferred.
- Prior experience in managed care settings is highly valued.
Compensation:
The salary range for this position is competitive and reflects the experience and qualifications of the candidate.
Benefits:
Elevance Health offers a comprehensive benefits package, including medical, dental, and vision coverage, along with retirement plans and wellness programs.
Company Overview:
Elevance Health is committed to improving lives and communities through innovative healthcare solutions. We are a Fortune 25 company focused on creating a culture that fosters personal and professional growth for our associates.
