Nurse Case Mgr I

Elevance Health • Latham, NY

20h • 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, including at hospitals for discharge planning.

This is a primarily virtual role, with required in-person training sessions. Candidates must reside within a reasonable commuting distance of a posting location unless an accommodation is granted as required by law. Work hours are generally 8:00 a.m.–4:30 p.m., with two 11:30 a.m.–8:00 p.m. shifts per month.

The listed salary range for New York is $70,560 to $105,840. Actual compensation depends on factors including geographic location, work experience, education, skill level, and business considerations. Elevance Health describes itself as a health company focused on improving lives and communities and making healthcare simpler.

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 if providing services in multiple states.
• For URAC-accredited areas, a BA/BS and 3 years of clinical care experience, or an equivalent combination of education and experience, and a current, active RN license in applicable state(s).

Nice To Haves

• Certification as a Case Manager.
• Residing in the Eastern or Central time zone.
• Telephonic coaching experience.
• For URAC-accredited areas, certification as a Case Manager and a BS in a health- or human-services-related field.

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 with problem solving involving providers, claims, or service issues.
• Perform care management duties telephonically or on-site, including hospital discharge planning.

Benefits

• Comprehensive benefits package, subject to eligibility requirements.
• Incentive and recognition programs.
• Equity stock purchase plan.
• 401(k) contribution.
• Merit increases.
• Paid holidays.
• Paid time off.
• Incentive bonus programs, unless covered by a collective bargaining agreement.
• Medical insurance.
• Dental insurance.
• Vision insurance.
• Short- and long-term disability benefits.
• 401(k) matching.
• Life insurance.
• Wellness programs.
• Financial education resources.

What This Job Offers

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