Telephonic Nurse Case Manager II

Elevance Health • Indianapolis, IN

1d • 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, performing duties telephonically. The position serves members in multiple states and requires multi-state licensure.

This virtually full-time role includes required in-person training sessions. Candidates must reside within a reasonable commuting distance of a posting location unless an accommodation is granted as required by law. The schedule is Monday through Friday, 10:00 a.m. to 6:30 p.m. Eastern Time, plus one or two holidays per year. The position supports the Federal Employee Program, which provides health benefits to federal employees, retirees, and their families.

Requirements

• Bachelor of Arts or Bachelor of Science 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 when providing services in multiple states.
• Ability to work Monday through Friday, 10:00 a.m. to 6:30 p.m. Eastern Time, plus one or two holidays per year.

Nice To Haves

• Case management experience.
• Utilization management experience.
• Certification as a Case Manager.
• At least two years of experience in an acute care setting.
• Experience with Microsoft Office and/or the ability to learn new computer programs, systems, and 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 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.
• Help resolve provider, 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-term disability benefits
• Long-term disability benefits
• 401(k) with company match
• Stock purchase plan
• Life insurance
• Wellness programs
• Financial education resources

What This Job Offers

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