Nurse Case Manager I

Elevance Health • St Louis, MO

7d • Remote

About The Position

Telephonic RN Nurse Case Manager Hours: Monday thru Friday 10:30am – 7pm Central Time Location: This role enables associates to work virtually full-time, with the exception of required in-person training sessions, providing maximum flexibility and autonomy. This approach promotes productivity, supports work-life integration, and ensures essential face-to-face onboarding and skill development. Please note that per our policy on hybrid/virtual work, candidates not within a reasonable commuting distance from the posting location(s) will not be considered for employment, unless an accommodation is granted as required by law. This position will service members in different states; therefore Multi-State Licensure will be required. The Telephonic Nurse Case Manager I is responsible for performing care management within the scope of licensure for members with complex and chronic care needs by assessing, developing, implementing, coordinating, monitoring, and evaluating care plans designed to optimize member health care across the care continuum. Performs duties telephonically or on-site such as at hospitals for discharge planning. How you will make an impact: Ensures members understand benefits and assist in access of services appropriate to their health needs. Conducts assessments to identify individual needs and a specific care management plan to address objectives and goals as identified during assessment. Implements care plan through actions based on assessments including providing education, facilitating authorizations/referrals as appropriate within benefits structure or through extra-contractual arrangements. Coordinates internal and external resources to meet identified needs. Monitors and evaluates effectiveness of the care management plan and modifies as necessary. Interfaces with Medical Directors and other health professionals on the development of care management treatment plans. Assists in problem solving for members and providers related to access to care, vendors, claims or service issues, etc.

Requirements

• Requires BA/BS in a health related field and minimum of 3 years of clinical experience; or any combination of education and experience, which would provide an equivalent background.
• Current, unrestricted compact RN license in your home state.
• Multi-state licensure is required if this individual is providing services in multiple states.

Nice To Haves

• Strong clinical background in hospital setting, i.e. Med Surg, ER, ICU, Critical Care
• Ability to talk, type and critically think at the same time.
• Demonstrates 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.
• Excellent collaboration, communication and teamwork skills.

Responsibilities

• Ensures members understand benefits and assist in access of services appropriate to their health needs.
• Conducts assessments to identify individual needs and a specific care management plan to address objectives and goals as identified during assessment.
• Implements care plan through actions based on assessments including providing education, facilitating authorizations/referrals as appropriate within benefits structure or through extra-contractual arrangements.
• Coordinates internal and external resources to meet identified needs.
• Monitors and evaluates effectiveness of the care management plan and modifies as necessary.
• Interfaces with Medical Directors and other health professionals on the development of care management treatment plans.
• Assists in problem solving for members and providers related to access to care, vendors, claims or service issues, etc.

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.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Number of Employees: 5,001-10,000 employees