RN Nurse Case Manager I

Elevance Health • Wallingford, OH

14d • Hybrid

About The Position

Nurse Case Manager I LOCATION : This is a virtual eligible role. You should be within a reasonable commuting distance from one of our offices. HOURS : Monday - Friday 9:00a - 5:30p ET with 2-4 late evening shifts per month, 11:30a to 8p ET. 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 Nurse Case Manager I is responsible for performing 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 or on-site as needed.

Requirements

• Requires 3 years of clinical experience; or any combination of education and experience, which would provide an equivalent background.
• Current, active, unrestricted RN license issued by the state in which you reside is required.
• As this position supports multiple states, compact or multi-state licensure is required.

Nice To Haves

• Previous case management experience is preferred.
• Home health experience, utilization management and/or hospital discharge planning experience is a plus.

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 plan and modifies as necessary.
• Interfaces with Medical Directors and Physician Advisors on the development of care management treatment plans.
• Assists in problem solving with providers, claims or service issues.
• Functions as preceptor for new care management staff.
• Works on special projects as assigned by manager.
• Other duties as assigned.

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: No Education Listed