Nurse Case Manager II

Elevance Health • Las Vegas, NV

1d • Remote

About The Position

The Telephonic Nurse Case Manager II is responsible for care management within the scope of licensure for members with complex and chronic care needs by assessing, developing, implementing, coordinating, monitoring, and evaluating care plans designed to optimize member health care across the care continuum. This role enables associates to work virtually full-time, providing maximum flexibility and autonomy, promoting productivity, supporting work-life integration, and ensuring essential face-to-face onboarding and skill development. The position performs duties telephonically and will service members in different states, requiring Multi-State Licensure.

Requirements

• BS in a health-related field
• Minimum of 5 years of nursing clinical experience
• Current, unrestricted RN license
• Multi-state licensure

Nice To Haves

• Experience with the Microsoft Office suite and/or the ability to learn new computer programs/systems/software quickly
• Ability to talk and type at the same time
• Background in an acute care setting (e.g., hospital/ED/ICU/med-surg)
• Telephonic and/or virtual nursing experience
• Managed Care experience
• Certification as a Case Manager
• Minimum 2 years experience in acute care setting

Responsibilities

• Ensures member access to services appropriate to their health needs.
• Conducts assessments to identify individual needs and a specific care management plan to address objectives and goals as identified during assessment.
• Assists in facilitating authorizations/referrals as appropriate within benefits structure or through extra-contractual arrangements.
• Coordinates internal and external resources to meet identified needs.
• Monitors and evaluates effectiveness of the care management plan and modifies as necessary.
• Interfaces with Medical Directors and other Health Professionals on the development of care management treatment plans.
• Assists in problem solving with providers, claims or service issues.
• Assists with development of utilization/care management policies and procedures.

Benefits

• comprehensive benefits package
• incentive and recognition programs
• equity stock purchase
• 401k contribution
• merit increases
• paid holidays
• Paid Time Off
• incentive bonus programs
• medical benefits
• dental benefits
• vision benefits
• short and long term disability benefits
• 401(k) +match
• stock purchase plan
• life insurance
• wellness programs
• financial education resources

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Number of Employees: 5,001-10,000 employees