Nurse Case Manager II Position
2 weeks ago
We are seeking a skilled Nurse Case Manager II to join our team at Elevance Health. As a key member of our care management team, you will be responsible for providing high-quality care to our members with complex and chronic care needs.
Key Responsibilities- Assess, develop, implement, coordinate, monitor, and evaluate care plans to optimize member health care 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.
- Assist with development of utilization/care management policies and procedures.
- Requires 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 required.
- Multi-state licensure is required if this individual is providing services in multiple states.
- Certification as a Case Manager is preferred.
- Compact RN license preferred.
- Minimum 2 years' experience in acute care setting.
- Managed Care experience.
- 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.
Salary Range: $75,684 to $124,338. Benefits: Comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution.
Location: California; Colorado; Maryland; New York. Work Environment: Hybrid Workforce Strategy. Associates are required to work at an Elevance Health location at least once per week, and potentially several times per week.
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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