Telephonic Nurse Case Manager II

Elevance Health • Tampa, FL

1d • $75,680 - $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 to optimize member health care across the care continuum. Duties are performed telephonically. The position serves members in multiple states and requires multi-state licensure.

The role is primarily virtual, with required in-person training sessions. Candidates generally must live within reasonable commuting distance of a posting location unless an accommodation is granted as required by law. Scheduled hours are Monday through Friday, 9:00 a.m. to 5:30 p.m., with two to four evenings per month from 11:30 a.m. to 8:00 p.m. The listed salary range for candidates working in person or virtually in New York or Virginia is $75,680 to $119,196. Elevance Health offers a comprehensive benefits package, subject to eligibility requirements.

Requirements

• A bachelor's degree in a health-related field and at least five years of clinical experience, or an equivalent combination of education and experience.
• Current, unrestricted RN license in the applicable state.
• Multi-state licensure if providing services in multiple states.

Nice To Haves

• Case management experience.
• Case Manager certification.
• At least two years of experience in an acute care setting.
• 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 establish 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 needed.
• Interface with Medical Directors and Physician Advisors to develop care management treatment plans.
• Negotiate reimbursement rates, as applicable.
• Help resolve provider, claims, or service issues.
• Assist with developing utilization and care management policies and procedures.

Benefits

• Comprehensive benefits package, subject to eligibility requirements.
• Incentive and recognition programs.
• Equity stock purchase.
• 401(k) contribution.
• Merit increases.
• Paid holidays.
• Paid Time Off.
• Incentive bonus programs, unless covered by a collective bargaining agreement.
• Medical, dental, and 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