Telephonic Nurse Case Manager II

Elevance Health • Atlanta, GA

2d • Remote

About The Position

The Telephonic Nurse Case Manager II manages care 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. Duties are performed telephonically.

This is a virtual, full-time role, except for required in-person training sessions. Candidates must be within reasonable commuting distance of the posting location(s), unless an accommodation is granted as required by law. The position serves members in multiple states and requires multi-state licensure. Hours are Monday through Friday, 9:00 a.m. to 5:30 p.m., with one or two late evenings from 11:30 a.m. to 8:00 p.m., depending on time zone.

Elevance Health describes itself as a health company focused on improving lives and communities and simplifying health care. Its total rewards may include merit increases, paid holidays, paid time off, incentive bonus programs (unless covered by a collective bargaining agreement), medical, dental, vision, short- and long-term disability benefits, a 401(k) with match, stock purchase plan, life insurance, wellness programs, and financial education resources.

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).
• Multi-state licensure is required 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 simultaneously.
• Critical thinking skills when interacting with members.
• Experience with Microsoft Office and/or ability to learn new computer programs, systems, or software quickly.
• Ability to manage, review, and respond to emails and instant messages in a timely manner.

Responsibilities

• Ensure members have access to services appropriate to their health needs.
• Conduct assessments to identify individual needs and develop care management plans addressing objectives and goals identified during assessment.
• 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 involving providers, claims, or service issues.
• Assist with developing 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