Nurse Case Manager I

Elevance Health • Indianapolis, IN

8d • 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 to optimize member health care across the care continuum. Duties are performed telephonically or on-site, such as at hospitals for discharge planning.

This role is described as virtually full-time, except for required in-person training sessions. Candidates must be within a reasonable commuting distance of the posting location(s), unless an accommodation is granted; alternate locations may be considered. The position is a first-shift, non-management exempt role.

Requirements

• Bachelor's degree 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.
• Ability to talk, type, and critically think at the same time.
• Demonstrated critical thinking skills when interacting with members.
• Experience with Microsoft Office and/or ability to learn new computer programs, systems, or 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 specific 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 the effectiveness of care management plans and modify them 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.
• Perform care management duties telephonically or on-site, including hospital discharge planning.

Benefits

• Merit increases
• Paid holidays
• Paid Time Off
• Incentive bonus programs (unless covered by a collective bargaining agreement)
• Medical benefits
• Dental benefits
• 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