Telephonic Nurse Case Manager II

Elevance Health•Tampa, FL

3d•$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 designed to optimize member health care across the care continuum, and performs duties telephonically. The position is primarily virtual, with required in-person training sessions. Candidates must be within a reasonable commuting distance of the posting location unless an accommodation is granted. The role serves members in multiple states and requires multistate licensure. 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 shift from 11:30 a.m.–8:00 p.m. EST.

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

Nice To Haves

Certification as a Case Manager.
A 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 specific 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 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 involving providers, claims, or service issues.
Assist with the development of utilization and care management policies and procedures.