Nurse Case Mgr I (US)

Elevance Health • Wallingford, CT

10d • 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 members’ healthcare across the care continuum. Duties are performed telephonically or on-site, including at hospitals for discharge planning. The position is primarily virtual, with required in-person training sessions. Candidates must be within a reasonable commuting distance of a posting location unless an accommodation is granted as required by law.

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

• Case Manager certification is preferred.
• A bachelor’s degree in a health- or human-services-related field is preferred.

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 on developing care management treatment plans.
• Negotiate reimbursement rates, as applicable.
• Assist with resolving provider, claims, or service issues.
• Perform duties telephonically or on-site, including hospital discharge planning.

Benefits

• Comprehensive benefits package, subject to eligibility requirements.
• Incentive and recognition programs.
• Equity stock purchase.
• 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.
• Stock purchase plan.
• Life insurance.
• Wellness programs.
• Financial education resources.

What This Job Offers

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