Telephonic Nurse Case Manager ll

Elevance Health • Atlanta, GA

3d • Remote

About The Position

The Telephonic Nurse Case Manager II provides care management within the scope of RN licensure for members with complex and chronic care needs. The role assesses, develops, implements, coordinates, monitors, and evaluates care plans intended to optimize members’ health care across the care continuum. Duties are performed telephonically. The position is virtually full-time, except for required in-person training sessions; candidates generally must live within reasonable commuting distance of a posting office unless an accommodation is granted. The schedule is Monday through Friday, 9:00 a.m. to 5:30 p.m. EST, plus one late evening from 11:30 a.m. to 8:00 p.m. EST. Multi-state licensure is required to serve members in multiple states, and applicants who meet minimum requirements must complete an online pre-employment skills assessment within 48 hours of receiving it.

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 the applicable state.
• Multi-state licensure when providing services in multiple states.
• Complete the online pre-employment skills assessment within 48 hours of receipt and meet its criteria.

Nice To Haves

• Case management experience.
• Certification as a Case Manager.
• At least 2 years of experience in an acute care setting.
• Managed care experience.
• Ability to talk and type simultaneously.
• 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 establish care management plans 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 meet identified needs.
• Monitor and evaluate care management plans and modify them as necessary.
• Interface with Medical Directors and Physician Advisors on the development of care management treatment plans.
• Negotiate reimbursement rates, as applicable.
• Assist with problem-solving provider, claims, or service issues.
• Assist with developing utilization and care management policies and procedures.

Benefits

• Comprehensive benefits package, subject to eligibility requirements.
• Incentive and recognition programs.
• Equity stock purchase and 401(k) contribution.
• Merit increases.
• Paid holidays.
• Paid Time Off.
• Incentive bonus programs, unless covered by a collective bargaining agreement.
• Medical insurance.
• Dental insurance.
• Vision insurance.
• Short- and 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