Nurse Case Manager II

Elevance Health•St. Louis, MO

2d•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 to optimize member health care across the care continuum. Duties are performed telephonically. The position is primarily virtual, with in-person training sessions required; alternate locations may be considered for candidates within commuting distance of an office. Candidates must be available to work an eight-hour shift between 8:00 a.m. and 8:00 p.m.

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.
A current, unrestricted RN license in applicable state(s).
Multi-state licensure is required when providing services in multiple states.

Nice To Haves

Certification as a Case Manager is preferred.
Previous experience as a case manager is strongly preferred.
For URAC-accredited areas, a BS in a health or human services-related field is preferred.

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 plan effectiveness and modify plans as necessary.
Interface with Medical Directors and Physician Advisors on care management treatment plan development.
Negotiate reimbursement rates, as applicable.
Assist with resolving provider, claims, or service issues.
Assist with developing utilization and care management policies and procedures.