Nurse Case Manager I

Elevance Health • Indianapolis, IN

2d • Remote

About The Position

The Nurse Case Manager I performs care management within the scope of licensure for members with complex and chronic care needs. The role assesses, develops, implements, coordinates, monitors, and evaluates care plans designed to optimize member health care across the care continuum. Duties are performed telephonically or on-site, such as at hospitals for discharge planning. The role enables associates to work virtually full-time, except for required in-person training sessions. Candidates must live within reasonable commuting distance of a posting location unless a legally required accommodation is granted.

Requirements

• A BA/BS in a health-related field and at least 3 years of clinical experience, or an equivalent combination of education and experience.
• Current, unrestricted RN license in applicable state(s).
• Multi-state licensure is required if providing services in multiple states.

Nice To Haves

• Certification as a Case Manager.
• Previous experience with utilization review and/or prior authorization.
• Clinical case management experience in an inpatient or outpatient setting.
• Critical-thinking skills when interacting with members.
• Experience with Microsoft Office and/or ability to learn new computer programs, systems, and software quickly.
• Ability to manage, review, and respond to emails and instant messages in a timely fashion.
• Excellent collaboration, communication, and teamwork skills.

Responsibilities

• Ensure members have access to services appropriate to their health needs.
• Conduct assessments to identify individual needs and develop care management plans with objectives and goals.
• Implement care plans by facilitating authorizations and referrals within the benefits structure or through extra-contractual arrangements.
• Coordinate internal and external resources to meet identified needs.
• Monitor and evaluate care plan effectiveness and modify plans as necessary.
• Interface with Medical Directors and Physician Advisors to develop care management treatment plans.
• Negotiate reimbursement rates, as applicable.
• Assist in resolving provider, claims, or service issues.

Benefits

• Comprehensive benefits package, subject to eligibility requirements.
• Incentive and recognition programs.
• Equity stock purchase and 401(k) contribution.
• Merit increases.
• Paid holidays.
• Paid Time Off.
• Incentive bonus programs, unless covered by a collective bargaining agreement.
• Medical, dental, and vision benefits.
• Short- and long-term disability benefits.
• 401(k) with match.
• Stock purchase plan.
• Life insurance.
• Wellness programs.
• Financial education resources.

What This Job Offers

• Job Type: Full-time
• Career Level: Entry Level