Telephonic Nurse Case Manager II

Elevance Health•Tampa, FL

1d•$79,464 - $119,196•Remote

About The Position

The Telephonic Nurse Case Manager II provides 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 intended to optimize member health care across the care continuum, and performs duties telephonically. The position serves members in multiple states and requires multistate licensure. The role is designed to be virtually full-time, with required in-person training sessions; candidates generally must live within a reasonable commuting distance of a posting location unless an accommodation is granted. Scheduled hours are Monday through Friday, either 9:00 a.m.–5:30 p.m. EST or 9:30 a.m.–6:00 p.m. EST, plus one late evening, 11:30 a.m.–8:00 p.m. EST. A free online pre-employment skills assessment is required; candidates who meet minimum qualifications must complete it within 48 hours of receiving instructions and meet the assessment criteria. Elevance Health offers a comprehensive benefits package, incentive and recognition programs, and an equity stock purchase plan, subject to eligibility. The stated New York salary range is $79,464–$119,196; actual compensation may vary based on factors including location, experience, education, and skills.

Requirements

BA/BS 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 applicable state(s).
Multistate licensure if providing services in multiple states.
Ability to complete the required online pre-employment skills assessment within 48 hours of receiving instructions and meet its criteria.

Nice To Haves

Certification as a Case Manager.
Bachelor’s degree in a health- or human-services-related field.
At least 2 years of experience in an acute care setting.
Managed care experience.
Ability to talk and type at the same time.
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 care management plans with objectives and goals.
Implement care plans by facilitating authorizations and referrals within the benefits structure or through extra-contractual arrangements, as appropriate.
Coordinate internal and external resources to meet identified needs.
Monitor and evaluate care management plan effectiveness and modify plans as necessary.
Interface with Medical Directors and Physician Advisors to develop care management treatment plans.
Negotiate reimbursement rates, as applicable.
Assist with problem solving related to providers, claims, or service issues.
Assist with developing utilization and care management policies and procedures.