Case Manager for Health Homes program at Family Service League in Bay Shore, managing a caseload of clients with intensive needs. Requires a Bachelor's degree and experience in health - related fields.
About the role
- Senior Telephonic Nurse Case Manager for Elevance Health managing complex healthcare needs. Overseeing care management plans with a focus on member health across multiple states.
Responsibilities
- Responsible for care management within the scope of licensure for members with complex and chronic care needs
- Assess, develop, implement, coordinate, monitor, and evaluate care plans designed to optimize member health care across the care continuum
- Conduct assessments to identify individual needs and a specific care management plan
- Implement care plan by facilitating authorizations/referrals as appropriate
- Coordinate internal and external resources to meet identified needs
- Monitor and evaluate effectiveness of the care management plan
- 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
- Participate in department audit activities
Requirements
- Requires BA/BS in a health related field
- minimum of 5 years of clinical experience
- Current, unrestricted RN license in applicable state(s) required
- Certification as a Case Manager preferred
- Ability to talk and type at the same time preferred
- Demonstrate critical thinking skills when interacting with members preferred
- Experience with Microsoft Office and/or ability to learn new computer programs/systems/software quickly preferred
- Minimum 2 years’ experience in acute care setting preferred
- Minimum 2 years’ telephonic Case Management experience with a Managed Care Company preferred
- Managed Care experience preferred.
Benefits
- comprehensive benefits package
- incentive and recognition programs
- equity stock purchase
- 401k contribution
- Paid Time Off
- paid holidays
- medical benefits
- dental benefits
- vision benefits
- short and long term disability benefits
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