Nurse Case Mgr II (US)
About The Position
The Telephonic NICU Nurse Case Manager II 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 members’ health care across the care continuum. Duties are performed telephonically or on-site, such as at hospitals for discharge planning. This virtual full-time role generally works Monday through Friday, 8:00 a.m. to 4:30 p.m. Eastern Time. Required in-person training sessions are an exception to virtual work. Candidates generally must live within a reasonable commuting distance of a listed posting location, unless an accommodation is granted as required by law. For candidates working in person or virtually in New York, the posted salary range is $79,464 to $119,196. Actual compensation may vary based on geographic location, experience, education, skill level, and other stated business and market considerations. Elevance Health offers a comprehensive benefits package, subject to eligibility requirements.
Requirements
- Bachelor’s degree 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 is required if providing services in multiple states.
Nice To Haves
- NICU experience strongly preferred.
- Certification as a Case Manager.
- Managed Care experience.
- Ability to talk and type at the same time.
- Critical thinking skills when interacting with members.
- Experience with Microsoft Office and/or ability to learn new computer programs, systems, and software quickly.
- Ability to manage, review, and respond to emails and instant messages in a timely fashion.
- Knowledge of health insurance and benefits, the medical management process, care management, and utilization review management.
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, as appropriate.
- Coordinate internal and external resources to meet identified needs.
- Monitor and evaluate care management 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.
- Help resolve provider, claims, or service issues.
- Assist with developing utilization and care management policies and procedures.
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, dental, and 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
