Telephonic Nurse Case Manager I

Elevance Health•Atlanta, GA

19h•Remote

About The Position

The Telephonic Nurse Case Manager I provides telephonic 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’ healthcare across the care continuum. The position is primarily virtual, with required in-person training sessions, and candidates must reside in Georgia and be within reasonable commuting distance of the posting location unless an accommodation is granted. The role serves members in multiple states and requires multistate licensure. The schedule is Monday through Friday, 11:00 a.m. to 7:30 p.m., with one 8:30 a.m. to 5:00 p.m. EST shift per week. Candidates who meet minimum requirements will be asked to complete a free online pre-employment skills assessment within 48 hours of receiving instructions. This is a non-management exempt position in the Licensed Nurse job family. Elevance Health offers market-competitive total rewards, including merit increases, paid holidays, paid time off, incentive bonus programs (unless covered by a collective bargaining agreement), medical, dental, vision, short- and long-term disability benefits, a 401(k) with matching, a stock purchase plan, life insurance, wellness programs, and financial education resources.

Requirements

Bachelor’s degree in a health-related field.
Three years of clinical experience, or an equivalent combination of education and experience.
Current, unrestricted RN license from the State of Georgia.
Multistate licensure when providing services in multiple states.

Nice To Haves

Ability to talk and type at the same time.
Certification as a Case Manager.
Demonstrated critical-thinking skills when interacting with members.
Experience with Microsoft Office and/or ability to learn new computer programs, systems, and software quickly.
Ability to manage, review, and respond to emails and instant messages in a timely fashion.

Responsibilities

Ensure members have access to services appropriate to their health needs.
Conduct assessments to identify individual needs and develop a specific care management plan with objectives and goals.
Implement care plans by facilitating authorizations and referrals within the benefits structure or through extra-contractual arrangements.
Coordinate internal and external resources to address identified needs.
Monitor and evaluate the effectiveness of care management plans and modify them as needed.
Interface with Medical Directors and Physician Advisors on the development of care management treatment plans.
Assist with problem solving related to providers, claims, or service issues.
Assist with developing utilization and care management policies and procedures.