Nurse Case Manager I (US)

Elevance Health•Latham, NY

1d•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 and may also be performed on-site, such as at hospitals for discharge planning. The position is primarily virtual, with required in-person training sessions. Candidates must live within a reasonable commuting distance of a listed office unless an accommodation is granted as required by law. The schedule is Monday through Friday, 8:00 a.m. to 4:30 p.m. EST, with 2–4 required evening shifts per month from 11:00 a.m. to 8:30 p.m.

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, active, 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 to develop care management treatment plans.
Negotiate reimbursement rates, as applicable.
Assist with problem-solving involving providers, claims, or service issues.