Telephonic RN Nurse Case Manager at Elevance Health managing complex member care needs with a focus on optimizing health care. Responsibilities include conducting assessments, implementing care plans, and coordinating resources.
Responsibilities
Ensures members understand benefits and assist in access of 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 through actions based on assessments including providing education, 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 other health professionals on the development of care management treatment plans.
Assists in problem solving for members and providers related to access to care, vendors, claims or service issues, etc.
Requirements
Requires BA/BS in a health related field and minimum of 3 years of clinical experience;
Current, unrestricted compact RN license in your home state.
Multi-state licensure is required if providing services in multiple states.
Strong clinical background in hospital setting, i.e. Med Surg, ER, ICU, Critical Care
Ability to talk, type and critically think at the same time.
Demonstrates 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.
Excellent collaboration, communication, and teamwork skills.
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