Telephonic Nurse Case Manager II

Elevance Health • Latham, NY

1d • 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, and performs duties telephonically.

The role is virtually full-time, with in-person training sessions required. Candidates must be within a reasonable commuting distance of a posting location unless an accommodation is granted. The schedule is Monday through Friday, 8:30 a.m. to 5:00 p.m. in the employee’s time zone, with 2–4 late shifts per month from 11:30 a.m. to 8:00 p.m. Eastern Time. The position serves members in multiple states and requires multi-state licensure.

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 the applicable state.
• Multi-state licensure if 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.
• 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 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 related to providers, 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 plan.
• 401(k) contribution.
• Merit increases.
• Paid holidays.
• Paid Time Off.
• Incentive bonus programs, unless covered by a collective bargaining agreement.
• Medical insurance.
• Dental insurance.
• Vision insurance.
• Short- and long-term disability benefits.
• 401(k) match.
• Life insurance.
• Wellness programs.
• Financial education resources.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level