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Registered Nurse Case Manager I

2 months ago

Richmond, Virginia, United States Elevance Health Full time

LOCATION:
This is a remote position for our Central area. You must reside in the Central region, with Virginia residency being a requirement.

HOURS:
Standard business hours, Monday through Friday.

TRAVEL:
Occasional visits to a provider or member may be necessary.


As a Registered Nurse Case Manager I, you will be responsible for delivering care management within the scope of your licensure for members with intricate and chronic care requirements. This involves assessing, developing, implementing, coordinating, monitoring, and evaluating care plans aimed at optimizing member health care throughout the care continuum.

Duties may be performed telephonically or on-site as required.

Key Responsibilities:

1. Ensure members have access to services that align with their health needs.


2. Conduct thorough assessments to determine individual needs and formulate a specific care management plan that addresses the objectives and goals identified during the assessment.


3. Implement the care plan by facilitating authorizations/referrals as appropriate within the benefits structure or through extra-contractual arrangements.

4. Coordinate both internal and external resources to meet identified needs.

5. Monitor and evaluate the effectiveness of the care plan, making modifications as necessary.

6. Collaborate with Medical Directors and Physician Advisors to develop care management treatment plans.

7. Assist in resolving issues related to providers, claims, or services.

8. Serve as a mentor for new care management staff.

9. Participate in special projects as assigned by management.

10. Perform other duties as assigned.

Required Qualifications:

• A minimum of 3 years of clinical experience; or any combination of education and experience that would provide an equivalent background.

• A current, active, unrestricted RN license from the Commonwealth of Virginia.

Preferred Qualifications:

• Previous experience in case management is preferred.

• Experience in Behavioral Health and/or working with individuals with intellectual/developmental disabilities is highly valued.

• Home health experience, utilization management, and/or hospital discharge planning experience is advantageous.