Nurse Case Manager 1 100% Virtual, Carebridge
About The Position
CareBridge Health, a member of the Elevance Health family of companies within the Carelon business, is seeking a Nurse Case Manager I. This role is 100% virtual and focuses on enabling individuals in home and community-based settings to maximize their health, independence, and quality of life through home-care and community-based services. The Nurse Case Manager I is responsible for performing care management within the scope of licensure for members with complex and chronic care needs. This involves assessing, developing, implementing, coordinating, monitoring, and evaluating care plans designed to optimize member health care across the care continuum. Duties can be performed telephonically or on-site, such as at hospitals for discharge planning.
Requirements
- BA/BS in a health related field and minimum of 3 years of clinical experience; or any combination of education and experience, which would provide an equivalent background.
- Current, unrestricted RN license in applicable state(s) required.
- Multi-state licensure is required if this individual is providing services in multiple states.
Nice To Haves
- Certification as a Case Manager is preferred.
- Prior case management experience is strongly preferred.
- Home health experience is strongly preferred.
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.
- Implements care plan by 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 Physician Advisors on the development of care management treatment plans.
- Negotiates rates of reimbursement, as applicable.
- Assists in problem solving with providers, claims or service issues.
Benefits
- merit increases
- paid holidays
- Paid Time Off
- incentive bonus programs
- medical
- dental
- vision
- short and long term disability benefits
- 401(k) +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
