Telephonic Nurse Case Manager II
Elevance Health • Woodland Hills, CA4d • Remote
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Telephonic Nurse Case Manager II, California
Elevance Health•Woodland Hills, CA
•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 members, develops and implements care plans, coordinates resources, and monitors and evaluates outcomes to optimize health care across the care continuum. Duties are performed telephonically. This is a virtual full-time role serving California, with required in-person training sessions. The position serves members in multiple states and requires multi-state licensure. Work 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.
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 California RN license.
- 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.
- 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, 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 plans and modify them as necessary.
- Interface with Medical Directors and Physician Advisors to develop care management treatment plans.
- Negotiate reimbursement rates, as applicable.
- Assist with resolving 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 and 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.
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
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