Nurse Case Manager II

Elevance Health • Atlanta, GA

3d • 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 intended to optimize members’ health care across the care continuum. Duties are performed telephonically.

This position is virtual full-time, except for required in-person training sessions. Candidates must reside within a reasonable commuting distance of an office location unless an accommodation is granted as required by law. The schedule is Monday through Friday, 9:00 a.m. to 5:30 p.m., with one 11:30 a.m. to 8:00 p.m. shift each week.

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.
• For URAC-accredited areas, a bachelor’s degree and at least 5 years of clinical care experience, or an equivalent combination of education and experience, is required.
• For URAC-accredited areas, a current and active RN license in applicable state(s) is required; multi-state licensure is required when providing services in multiple states.

Nice To Haves

• Certification as a Case Manager.
• For URAC-accredited areas, 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 care management plans addressing the objectives and goals identified during assessment.
• 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 the effectiveness of care management plans and modify them as necessary.
• Interface with Medical Directors and Physician Advisors on the development of care management treatment plans.
• Negotiate reimbursement rates, as applicable.
• Assist with problem solving involving providers, 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 matching
• Stock purchase plan
• Life insurance
• Wellness programs
• Financial education resources

What This Job Offers

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