Elevance Health
Overview
Telephonic Nurse Case Manager II – Remote/Hybrid role. Location and hybrid/virtual work policies apply. Hours: Monday - Friday 9:00am to 5:30pm EST with one late evening 11:30am to 8:00pm EST. In-person training sessions may be required. Alternate locations considered if within commuting distance from an office. Candidates not within a reasonable commuting distance may not be considered unless an accommodation is granted by law.
Responsibilities
Care management within the scope of licensure for members with complex and chronic care needs; assess, develop, implement, coordinate, monitor, and evaluate care plans to optimize member health across the care continuum. Duties performed telephonically.
Ensure member access to services appropriate to their health needs.
Conduct assessments to identify needs and create specific care management plans.
Implement care plans by facilitating authorizations/referrals within benefits structure or through extra-contractual arrangements.
Coordinate internal and external resources to meet identified needs.
Monitor and evaluate the effectiveness of care management plans and modify as necessary.
Interface with Medical Directors and Physician Advisors on treatment plan development.
Negotiate rates of reimbursement, as applicable; assist with problem solving with providers, claims, or service issues.
Contribute to development of utilization/care management policies and procedures.
Minimum Requirements
Requires BA/BS in a health-related field and minimum of 5 years of clinical experience; or equivalent combination of education and experience.
Current, unrestricted RN license in applicable state(s).
Multi-state licensure required if providing services in multiple states.
For URAC accredited areas: BA/BS and minimum 5 years of clinical care experience; current active RN license in applicable state(s); multi-state licensure required.
Preferred Capabilities, Skills, And Experiences
Certification as a Case Manager preferred.
Ability to talk and type at the same time and demonstrate critical thinking when interacting with members.
Experience with Microsoft Office and ability to learn new programs quickly.
Ability to manage, review, and respond to emails/instant messages promptly.
Minimum 2 years’ experience in acute care setting; at least 2 years’ telephonic Case Management with a Managed Care Company; Managed Care experience preferred.
Salary and Location Salary range for this position at the specified location(s) is $76,944 to $126,408. Locations include: Colorado, Maryland, Massachusetts, New Jersey, Washington State. Benefits and compensation details are provided in the company overview.
About Elevance Health Elevance Health is a health company focused on improving lives and communities. We are a Fortune 25 company offering market-competitive total rewards, including medical, dental, vision, 401(k) match, stock purchase plan, and wellness programs. We operate with a Hybrid Workforce Strategy and may require time onsite. Vaccination requirements apply for certain patient/member-facing roles as described in policy. Elevance Health is an Equal Employment Opportunity employer. Applicants requiring accommodation in the job application process may contact elevancehealthjobssupport@elevancehealth.com. See also statements regarding fair chance employment where applicable.
Note: This description reflects current policy and program details and is subject to change.
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Responsibilities
Care management within the scope of licensure for members with complex and chronic care needs; assess, develop, implement, coordinate, monitor, and evaluate care plans to optimize member health across the care continuum. Duties performed telephonically.
Ensure member access to services appropriate to their health needs.
Conduct assessments to identify needs and create specific care management plans.
Implement care plans by facilitating authorizations/referrals within benefits structure or through extra-contractual arrangements.
Coordinate internal and external resources to meet identified needs.
Monitor and evaluate the effectiveness of care management plans and modify as necessary.
Interface with Medical Directors and Physician Advisors on treatment plan development.
Negotiate rates of reimbursement, as applicable; assist with problem solving with providers, claims, or service issues.
Contribute to development of utilization/care management policies and procedures.
Minimum Requirements
Requires BA/BS in a health-related field and minimum of 5 years of clinical experience; or equivalent combination of education and experience.
Current, unrestricted RN license in applicable state(s).
Multi-state licensure required if providing services in multiple states.
For URAC accredited areas: BA/BS and minimum 5 years of clinical care experience; current active RN license in applicable state(s); multi-state licensure required.
Preferred Capabilities, Skills, And Experiences
Certification as a Case Manager preferred.
Ability to talk and type at the same time and demonstrate critical thinking when interacting with members.
Experience with Microsoft Office and ability to learn new programs quickly.
Ability to manage, review, and respond to emails/instant messages promptly.
Minimum 2 years’ experience in acute care setting; at least 2 years’ telephonic Case Management with a Managed Care Company; Managed Care experience preferred.
Salary and Location Salary range for this position at the specified location(s) is $76,944 to $126,408. Locations include: Colorado, Maryland, Massachusetts, New Jersey, Washington State. Benefits and compensation details are provided in the company overview.
About Elevance Health Elevance Health is a health company focused on improving lives and communities. We are a Fortune 25 company offering market-competitive total rewards, including medical, dental, vision, 401(k) match, stock purchase plan, and wellness programs. We operate with a Hybrid Workforce Strategy and may require time onsite. Vaccination requirements apply for certain patient/member-facing roles as described in policy. Elevance Health is an Equal Employment Opportunity employer. Applicants requiring accommodation in the job application process may contact elevancehealthjobssupport@elevancehealth.com. See also statements regarding fair chance employment where applicable.
Note: This description reflects current policy and program details and is subject to change.
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