Telephonic Nurse Case Manager II

Elevance Health•Wallingford, CT

1d•Remote

About The Position

The Telephonic Nurse Case Manager II is responsible for 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. Performs duties telephonically.

Requirements

Requires BA/BS in a health related field and minimum of 5 years of clinical experience; or any combination of education and experience, which would provide an equivalent background.
Current, unrestricted RN license in applicable state(s) required.
Multi-state licensure is required if this individual is providing services in multiple states.
For URAC accredited areas the following applies: Requires a BA/BS and minimum of 5 years of clinical care experience; or any combination of education and experience, which would provide an equivalent background.
Current and active RN license required in applicable state(s).
Multi-state licensure is required if this individual is providing services in multiple states.

Nice To Haves

Certification as a Case Manager preferred.
Ability to talk and type at the same time preferred.
Demonstrate critical thinking skills when interacting with members preferred.
Experience with (Microsoft Office) and/or ability to learn new computer programs/systems/software quickly preferred.
Ability to manage, review and respond to emails/instant messages in a timely fashion preferred.
Minimum 2 years’ experience in acute care setting preferred.
Minimum 2 years’ "telephonic" Case Management experience with a Managed Care Company preferred.
Managed Care experience preferred.

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 Advisors on the development of care management treatment plans.
Negotiates rates of reimbursement, as applicable.
Assists in problem solving with providers, claims or service issues.
Assists with development of utilization/care management policies and procedures.