Nurse Case Mgr II (US)

Elevance Health • Louisville, KY

4d • Remote

About The Position

The Nurse Case Mgr 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 members’ health care across the care continuum. Duties are performed telephonically. The position requires residence in Kentucky and enables virtual full-time work, except for required in-person training sessions. The scheduled hours are Monday through Friday, 11:30 a.m. to 8 p.m.

Requirements

• A 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 Kentucky.
• Multi-state licensure if providing services in multiple states.
• Must reside in Kentucky.

Nice To Haves

• Certification as a Case Manager is preferred.

Responsibilities

• Ensure members have access to services appropriate to their health needs.
• Conduct assessments to identify individual needs and develop care management plans addressing 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 care plan effectiveness and modify plans as necessary.
• Interface with Medical Directors and Physician Advisors on the development of care management treatment plans.
• 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-term disability benefits
• Long-term disability benefits
• 401(k) with match
• Stock purchase plan
• Life insurance
• Wellness programs
• Financial education resources

What This Job Offers

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