Telephonic Nurse Case Manager I

Elevance Health•Atlanta, GA

1d•Remote

About The Position

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. The Telephonic Nurse Case Manager I is responsible for telephonic 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.

Requirements

Requires a BA/BS in a health-related field.
3 years of clinical experience; or any combination of education and experience, which would provide an equivalent background.
Current, unrestricted RN license from the State of Georgia required.
Multistate licensure is required if this individual is providing services in multiple states.
Must reside in the State of Georgia.
Ability to talk and type at the same time.
Demonstrate critical thinking skills when interacting with members.
Ability to manage, review and respond to emails/instant messages in a timely fashion.

Nice To Haves

Certification as a Case Manager.
Experience with (Microsoft Office) and/or ability to learn new computer programs/systems/software quickly.

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 management plan and modifies as necessary.
Interfaces with Medical Directors and Physician Advisor's on the development of care management treatment plans.
Assists in problem solving with providers, claims or service issues.
Assists with development of utilization/care management policies and procedures.