Elevance Health
Telephonic Nurse Case Manager Senior
Sign on Bonus: $2000
Location: Virtual: Full‑time work from home with required in‑person training sessions; flexible schedule with possible on‑site interactions. Alternate locations may be considered if within commuting distance of an office.
Hours: Monday – Friday 9:00 am to 5:30 pm; occasional late evenings 11:30 am to 8:00 pm depending on time zone.
Multi‑State Licensure
required because this position serves members in different states.
Responsibilities
Ensure member access to services appropriate to their health needs.
Conduct assessments to identify individual needs and develop a care management plan.
Implement care plan by facilitating authorizations/referrals within the benefits structure or through extra‑contractual arrangements.
Coordinate internal and external resources to meet identified needs.
Monitor and evaluate the effectiveness of the care management plan and modify it as necessary.
Interface with Medical Directors and Physician Advisors on treatment plan development; negotiate reimbursement rates 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; present cases for Grand Rounds/Care Conferences and participate in interdepartmental or cross‑brand workgroups.
May require specialized knowledge of specific disease processes or traumatic injury and serve as preceptor for new staff.
Participate in department audit activities.
Minimum Requirements
BA/BS in a health‑related field and a minimum of 5 years of clinical experience; or an equivalent combination of education and experience.
Current, unrestricted RN license in applicable state(s).
Multi‑state licensure required for services across multiple states.
Preferred Capabilities, Skills and Experiences
Certification as a Case Manager preferred.
BS in a health or human services related field preferred.
Elevance Health is an Equal Employment Opportunity employer; all qualified applicants will receive consideration for employment without regard to protected characteristics. Applicants requiring accommodation can contact elevancehealthjobssupport@elevancehealth.com.
Qualified applicants with arrest or conviction records will be considered in accordance with all applicable federal, state, and local laws.
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Location: Virtual: Full‑time work from home with required in‑person training sessions; flexible schedule with possible on‑site interactions. Alternate locations may be considered if within commuting distance of an office.
Hours: Monday – Friday 9:00 am to 5:30 pm; occasional late evenings 11:30 am to 8:00 pm depending on time zone.
Multi‑State Licensure
required because this position serves members in different states.
Responsibilities
Ensure member access to services appropriate to their health needs.
Conduct assessments to identify individual needs and develop a care management plan.
Implement care plan by facilitating authorizations/referrals within the benefits structure or through extra‑contractual arrangements.
Coordinate internal and external resources to meet identified needs.
Monitor and evaluate the effectiveness of the care management plan and modify it as necessary.
Interface with Medical Directors and Physician Advisors on treatment plan development; negotiate reimbursement rates 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; present cases for Grand Rounds/Care Conferences and participate in interdepartmental or cross‑brand workgroups.
May require specialized knowledge of specific disease processes or traumatic injury and serve as preceptor for new staff.
Participate in department audit activities.
Minimum Requirements
BA/BS in a health‑related field and a minimum of 5 years of clinical experience; or an equivalent combination of education and experience.
Current, unrestricted RN license in applicable state(s).
Multi‑state licensure required for services across multiple states.
Preferred Capabilities, Skills and Experiences
Certification as a Case Manager preferred.
BS in a health or human services related field preferred.
Elevance Health is an Equal Employment Opportunity employer; all qualified applicants will receive consideration for employment without regard to protected characteristics. Applicants requiring accommodation can contact elevancehealthjobssupport@elevancehealth.com.
Qualified applicants with arrest or conviction records will be considered in accordance with all applicable federal, state, and local laws.
#J-18808-Ljbffr