Nurse Case Manager 1 100% Virtual, Carebridge
About The Position
CareBridge Health, a member of the Elevance Health family of companies within Carelon, 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. This is a 100% virtual role, offering maximum flexibility and autonomy, promoting productivity and work-life integration. While the role is primarily virtual, occasional in-person training sessions are required. Alternate locations may be considered if candidates reside within a commuting distance from an office. Candidates not within a reasonable commuting distance from the posting location(s) will not be considered unless an accommodation is granted as required by law.
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
- Performing care management within the scope of licensure for members with complex and chronic care needs.
- Assessing, developing, implementing, coordinating, monitoring, and evaluating care plans designed to optimize member health care across the care continuum.
- Performing duties telephonically or on-site such as at hospitals for discharge planning.
- Ensuring member access to services appropriate to their health needs.
- Conducting assessments to identify individual needs and a specific care management plan to address objectives and goals.
- Implementing care plan by facilitating authorizations/referrals as appropriate within benefits structure or through extra-contractual arrangements.
- Coordinating internal and external resources to meet identified needs.
- Monitoring and evaluating the effectiveness of the care management plan and modifying as necessary.
- Interfacing with Medical Directors and Physician Advisors on the development of care management treatment plans.
- Negotiating rates of reimbursement, as applicable.
- Assisting 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
