Nurse Case Manager II
Elevance Health•Louisville, KY
•Remote
About The Position
The Nurse Case Manager II provides 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 across the care continuum. Duties are performed telephonically. 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. The associate must be available for an 8-hour shift scheduled between 8:00 a.m. and 8:00 p.m.
Requirements
- A BA/BS in a health-related field and at least 5 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.
- Availability to work an 8-hour shift between 8:00 a.m. and 8:00 p.m.
Nice To Haves
- Certification as a Case Manager.
- Previous experience as a case manager.
- For URAC-accredited areas, a BS 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 create care management plans addressing identified 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 provider, claims, or service issues.
- Assist with developing utilization and care management policies and procedures.
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
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
