Nurse Case Manager II
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 designed to optimize member health care across the care continuum. Duties are performed telephonically. The position is based in Georgia and is virtual full-time except for required in-person training sessions; candidates must be within a reasonable commuting distance of a posting location unless an accommodation is granted as required by law. The schedule is Monday through Friday, 9:00 a.m.–5:30 p.m., with one 11:30 a.m.–8:00 p.m. shift each week. This is a non-management, exempt role on the Licensed Nurse job family. Elevance Health describes itself as a health company dedicated to improving lives and communities and making healthcare simpler.
Requirements
- A 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
- Certification as a Case Manager is preferred.
- A bachelor's degree in a health or human services-related field is preferred for URAC-accredited areas.
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 the effectiveness of care management plans and modify them as needed.
- Interface with Medical Directors and Physician Advisors on the development of care management treatment plans.
- Negotiate reimbursement rates, as applicable.
- Assist with problem solving related to providers, claims, or service issues.
- Assist with the development of 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
