Hybrid Nurse Case Manager II

at Elevance Health

• Job title: Nurse Case Manager II
• Job type: Full Time
• Experience level: Mid level, Senior
• Salary: $79,464 - $119,196 per year
• Degree requirement: Bachelor's Degree
• Location requirements: Hybrid, Atlanta, United States

About the role

• Telephonic Nurse Case Manager II managing complex care needs for members. Responsibilities include assessing, coordinating, and evaluating care plans while ensuring patient access to services.

Responsibilities

• Telephonic Nurse Case Manager II responsible for care management within the scope of licensure for members with complex and chronic care needs.
• Assessing, developing, implementing, coordinating, monitoring, and evaluating care plans designed to optimize member health care across the care continuum.
• Ensures member access to services appropriate to their health needs.
• Conducts assessments to identify individual needs and a specific care management plan to address objectives and goals as identified during assessment.
• Implements care plan by facilitating authorizations/referrals as appropriate within benefits structure or through extra-contractual arrangements.
• Coordinates internal and external resources to meet identified needs.
• Monitors and evaluates effectiveness of the care management plan and modifies as necessary.
• Interfaces with Medical Directors and Physician Advisors on the development of care management treatment plans.
• Negotiates rates of reimbursement, as applicable.
• Assists in problem-solving with providers, claims, or service issues.
• Assists with the development of utilization/care management policies and procedures.

Requirements

• Requires BA/BS in a health related field and minimum of 5 years of clinical experience; or any combination of education and experience, which would provide an equivalent background.
• Current, unrestricted RN license in applicable state(s) required.
• Multi-state licensure is required if this individual is providing services in multiple states.
• Case Management experience preferred.
• Certification as a Case Manager preferred.
• Minimum 2 years’ experience in acute care setting preferred.
• Managed Care experience preferred.
• Ability to talk and type at the same time.
• Demonstrate critical thinking skills when interacting with members.
• Experience with Microsoft Office and/or ability to learn new computer programs/systems/software quickly.
• Ability to manage, review and respond to emails/instant messages in a timely fashion.

Benefits

• comprehensive benefits package
• incentive and recognition programs
• equity stock purchase
• 401k contribution
• paid holidays
• Paid Time Off
• medical, dental, and vision benefits
• short and long term disability benefits
• wellness programs
• financial education resources