Elevance Health
Overview
Work Location: Virtual. Work Hours: Monday - Friday, 9am - 5:30pm (4 days) and 11:30am - 8pm (1 day) EST. This role enables associates to work virtually full-time, with the exception of required in-person training sessions, providing flexibility and autonomy. Candidates not within a reasonable commuting distance from the posting location(s) will not be considered unless an accommodation is granted as required by law. The
Nurse Case Manager Senior
is responsible for care management within the scope of licensure for members with complex and chronic care needs by assessing, developing, implementing, coordinating, monitoring, and evaluating care plans designed to optimize member health care across the care continuum. Duties may be performed telephonically or on-site (e.g., at hospitals for discharge planning). Responsibilities
Ensure member access to services appropriate to their health needs. Conduct assessments to identify individual needs and develop a specific care management plan to address objectives and goals identified during assessment. Implement care plans by facilitating authorizations/referrals as appropriate within benefits structure or through extra-contractual arrangements. Coordinate internal and external resources to meet identified needs. Monitor and evaluate effectiveness of the care management plan and modify as necessary. Interface with Medical Directors and Physician Advisors on the development of care management treatment plans. Negotiate rates of reimbursement, as applicable. Assist in problem solving with providers, claims or service issues. Assist with development of utilization/care management policies and procedures, chair and schedule meetings, and present cases for discussion at Grand Rounds/Care Conferences; participate in interdepartmental and/or cross-brand workgroups. Possible development of a focused skill set including comprehensive knowledge of specific disease processes or traumatic injuries; functions as preceptor for new staff; participate in department audits. Position Requirements
Requires BA/BS in a health-related field and minimum of 5 years of clinical experience; or an equivalent combination of education and experience. Current, unrestricted RN license in applicable state(s) required. Multi-state licensure required if services are provided in multiple states. Certification as a Case Manager is preferred. URAC and Certifications
For URAC-accredited areas: requires BA/BS and 5 years of clinical care experience; current and active RN license in applicable state(s); multi-state licensure; certification as a Case Manager; a BS in a health or human services-related field preferred. Compliance and About Elevance Health
Please be advised that Elevance Health only accepts resumes for compensation from agencies that have a signed agreement with Elevance Health. Any unsolicited resumes are the property of Elevance Health. Elevance Health is an Equal Employment Opportunity employer and all qualified applicants will receive consideration for employment without regard to age, citizenship status, color, creed, disability, ethnicity, genetic information, gender identity or expression, marital status, national origin, race, religion, sex, sexual orientation, veteran status or any other status protected by applicable laws. Applicants who require accommodation to participate in the job application process may contact elevancehealthjobssupport@elevancehealth.com for assistance. Qualified applicants with arrest or conviction records will be considered for employment in accordance with all laws.
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Work Location: Virtual. Work Hours: Monday - Friday, 9am - 5:30pm (4 days) and 11:30am - 8pm (1 day) EST. This role enables associates to work virtually full-time, with the exception of required in-person training sessions, providing flexibility and autonomy. Candidates not within a reasonable commuting distance from the posting location(s) will not be considered unless an accommodation is granted as required by law. The
Nurse Case Manager Senior
is responsible for care management within the scope of licensure for members with complex and chronic care needs by assessing, developing, implementing, coordinating, monitoring, and evaluating care plans designed to optimize member health care across the care continuum. Duties may be performed telephonically or on-site (e.g., at hospitals for discharge planning). Responsibilities
Ensure member access to services appropriate to their health needs. Conduct assessments to identify individual needs and develop a specific care management plan to address objectives and goals identified during assessment. Implement care plans by facilitating authorizations/referrals as appropriate within benefits structure or through extra-contractual arrangements. Coordinate internal and external resources to meet identified needs. Monitor and evaluate effectiveness of the care management plan and modify as necessary. Interface with Medical Directors and Physician Advisors on the development of care management treatment plans. Negotiate rates of reimbursement, as applicable. Assist in problem solving with providers, claims or service issues. Assist with development of utilization/care management policies and procedures, chair and schedule meetings, and present cases for discussion at Grand Rounds/Care Conferences; participate in interdepartmental and/or cross-brand workgroups. Possible development of a focused skill set including comprehensive knowledge of specific disease processes or traumatic injuries; functions as preceptor for new staff; participate in department audits. Position Requirements
Requires BA/BS in a health-related field and minimum of 5 years of clinical experience; or an equivalent combination of education and experience. Current, unrestricted RN license in applicable state(s) required. Multi-state licensure required if services are provided in multiple states. Certification as a Case Manager is preferred. URAC and Certifications
For URAC-accredited areas: requires BA/BS and 5 years of clinical care experience; current and active RN license in applicable state(s); multi-state licensure; certification as a Case Manager; a BS in a health or human services-related field preferred. Compliance and About Elevance Health
Please be advised that Elevance Health only accepts resumes for compensation from agencies that have a signed agreement with Elevance Health. Any unsolicited resumes are the property of Elevance Health. Elevance Health is an Equal Employment Opportunity employer and all qualified applicants will receive consideration for employment without regard to age, citizenship status, color, creed, disability, ethnicity, genetic information, gender identity or expression, marital status, national origin, race, religion, sex, sexual orientation, veteran status or any other status protected by applicable laws. Applicants who require accommodation to participate in the job application process may contact elevancehealthjobssupport@elevancehealth.com for assistance. Qualified applicants with arrest or conviction records will be considered for employment in accordance with all laws.
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