Remote Care Manager - RN

Elevance Health

3d • Remote

About The Position

Shift: Option of 5 8-hour shifts OR 4 10-hour shifts per week Location: Candidates in Texas, Tennessee, and Kansas preferred; PST, MST, CST time zones preferred Virtual: This role enables associates to work virtually full-time, with the exception of required in-person training sessions, 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 The Remote Care Manager – RN is responsible for providing telephonic support to patients and their families. Ensures communication and coordination with all stakeholders in the home, community, with payer partners and team members. Proactively manages a census of patients, ensuring quality interactions and follow through resulting in effective clinical outcomes. How you will make an impact: Makes outbound calls designed to build rapport/relationships and catch decline in patient status or acute issue prior to hospitalization or urgent visit need. Identifies patients with both chronic and acute needs to ensure their care plans are intact and assists with education, goals of care and ongoing care coordination. Identifies hospice eligibility, enters hospice orders and ensures smooth transitions of care. Communicates with company medical director about transition to sign the order and notifies the patients primary care physician (PCP). Contacts hospice agency to discuss case, verify receipt of order and date/time of visit. Follows up with hospice agency daily to verify admission or failed admission. Research failed admissions to find out why, notify team members and cancel hospice order if appropriate. Performs clinical evaluations and patient education as requested by interdisciplinary team. Communicates care plans to other external providers such as PCP, specialists, etc. Requests referrals to specialists. Communicates results of tests, lab work, etc. to advanced practice provider who notifies the patient and their family of the results. Completes documentation for durable medical equipment (DME) and documentation for Home Health which is sent to medical director for signature. Obtains authorizations for medications that are not on the formulary medication list.

Requirements

• Requires a HS diploma or equivalent and a minimum of 3 years of clinical experience; or any combination of education and experience, which would provide an equivalent background.
• Current valid active 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

• Experience in a centralized care management team preferred.
• Prior healthcare experience serving chronically ill patients preferred.
• Health plan, hospice or home health experience preferred.
• Telephonic case management or care coordination experience preferred.

Responsibilities

• Makes outbound calls designed to build rapport/relationships and catch decline in patient status or acute issue prior to hospitalization or urgent visit need.
• Identifies patients with both chronic and acute needs to ensure their care plans are intact and assists with education, goals of care and ongoing care coordination.
• Identifies hospice eligibility, enters hospice orders and ensures smooth transitions of care.
• Communicates with company medical director about transition to sign the order and notifies the patients primary care physician (PCP).
• Contacts hospice agency to discuss case, verify receipt of order and date/time of visit.
• Follows up with hospice agency daily to verify admission or failed admission.
• Research failed admissions to find out why, notify team members and cancel hospice order if appropriate.
• Performs clinical evaluations and patient education as requested by interdisciplinary team.
• Communicates care plans to other external providers such as PCP, specialists, etc.
• Requests referrals to specialists.
• Communicates results of tests, lab work, etc. to advanced practice provider who notifies the patient and their family of the results.
• Completes documentation for durable medical equipment (DME) and documentation for Home Health which is sent to medical director for signature.
• Obtains authorizations for medications that are not on the formulary medication list.

Benefits

• We offer a range of market-competitive total rewards that include merit increases, paid holidays, Paid Time Off, and incentive bonus programs (unless covered by a collective bargaining agreement), medical, dental, vision, short and long term disability benefits, 401(k) +match, stock purchase plan, life insurance, wellness programs and financial education resources, to name a few.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: High school or GED
• Number of Employees: 5,001-10,000 employees