Telephonic Nurse Case Manager II

Elevance Health • Tampa, FL

7d • $75,680 - $119,196 • Remote

About The Position

The Telephonic Nurse Case Manager II provides care management, within the scope of licensure, to members with complex and chronic care needs. The role assesses, develops, implements, coordinates, monitors, and evaluates care plans intended to optimize members’ 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 virtually full-time, except for required in-person training sessions. Candidates generally must live within a reasonable commuting distance of a posting location unless an accommodation is granted. Regular hours are Monday through Friday, 9:00 a.m. to 5:30 p.m., with 2–4 evenings per month from 11:30 a.m. to 8:00 p.m.

The position requires 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, as well as a current, unrestricted RN license in the applicable state. The salary range for candidates working in person or virtually in New York or Virginia is $75,680–$119,196.

Requirements

• Bachelor’s degree in a health-related field and a minimum of 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; this role serves members in different states.
• Ability to manage, review, and respond to emails and instant messages in a timely fashion.

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.

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 needed.
• Work 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 development of 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) matching.
• Stock purchase plan.
• Life insurance.
• Wellness programs.
• Financial education resources.

What This Job Offers

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