Telephonic Nurse Case Manager II

Elevance Health • St. Louis, MO

3d • Remote

About The Position

The Telephonic Nurse Case Manager II 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 designed to optimize member health care across the care continuum. The position is virtual full-time, except for required in-person training sessions; candidates must 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. Hours are Monday through Friday, 9:00 a.m. to 5:30 p.m., with one to two late evenings, 11:30 a.m. to 8:00 p.m., depending on time zone.

Requirements

• 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 applicable state(s).
• Multistate licensure when providing services in multiple states.

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 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.
• Coordinate internal and external resources to meet identified needs.
• Monitor and evaluate care-plan effectiveness and modify plans 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 related to providers, claims, or service issues.
• Assist with development of utilization and care management policies and procedures.

Benefits

• Merit increases
• Paid holidays
• Paid Time Off
• Incentive bonus programs, unless covered by a collective bargaining agreement
• Medical benefits
• Dental benefits
• Vision benefits
• 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