Nurse Case Manager II

Elevance Health•Las Vegas, NV

19h•Remote

About The Position

Telephonic Nurse Case Manager II Location: MST/PST This role enables associates to work virtually full-time, providing maximum flexibility and autonomy. This approach promotes productivity, supports work-life integration, and ensures essential face-to-face onboarding and skill development. Please note that per our policy on hybrid/virtual work, candidates not within a reasonable commuting distance from the posting location(s) will not be considered for employment, unless an accommodation is granted as required by law. Hours: Monday–Friday, 9:00 AM–5:30 PM (MST/PST), with two evening shifts each week from 11:30 AM–8:00 PM (in your time zone). This position will service members in different states; therefore, Multi-State Licensure will be required. 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. Performs duties telephonically. How you will make an impact: 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.

Requirements

Requires BS in a health-related field and minimum of 5 years of nursing clinical experience.
Current, unrestricted RN license is required.
Multi-state licensure will be required, as individuals will be providing services in multiple states.

Nice To Haves

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