Nurse Case Mgr II (US)

Elevance Health • Latham, NY

1d • Remote

About The Position

The 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 intended to optimize members’ 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 generally must live within a reasonable commuting distance of a posting location, unless an accommodation is granted as required by law. The schedule is Monday through Friday, 8:00 a.m.–4:30 p.m. Eastern Time, with two to three late evenings per month from 11:30 a.m.–8:00 p.m. The position is classified as non-management exempt and first shift.

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 the applicable state(s).
• Multi-state licensure is required when providing services in multiple states.

Nice To Haves

• Case Manager certification.
• A BS in a health- or human-services-related field.

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 care management plans and modify them as necessary.
• Work with Medical Directors and Physician Advisors on developing 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.
• 401(k) contribution.
• 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 company match.
• Stock purchase plan.
• Life insurance.
• Wellness programs.
• Financial education resources.

What This Job Offers

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