Nurse Case Manager I (US)

Elevance Health; New York (NY); On-site; USD 71,000 - 88,000; Full time

Benefits offered by this job

Comprehensive benefits package

Incentive programs

Equity stock purchase and 401k

Job summary

Elevance Health is seeking a Nurse Case Manager I (US) in Latham, NY. This role focuses on care management for members with complex needs, developing and implementing care plans to optimize health outcomes.

The position requires a BA/BS in a health-related field, a minimum of 3 years of clinical experience, and an unrestricted RN license with multi-state licensure if applicable. Comprehensive benefits are offered.

Qualifications

• BA/BS in a health-related field is required.
• Minimum of 3 years of clinical experience.
• Current, unrestricted RN license in applicable state(s) required.
• Multi-state licensure required if providing services in multiple states.
• Certification as a Case Manager preferred.

Responsibilities

• Ensure member access to services appropriate to their health needs.
• Conduct assessments to identify individual needs and develop care management plans.
• Implement care plans by facilitating authorizations/referrals as appropriate.
• 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 care management treatment plans.
• Negotiate rates of reimbursement, as applicable.
• Assist in problem solving with providers, claims, or service issues.

Skills

Care management

Clinical assessment

Care coordination

Education

BA/BS in a health-related field

Job description

About This Role

The Nurse Case Manager I (US) is responsible for performing care management for members with complex and chronic care needs, focusing on assessing, developing, implementing, coordinating, monitoring, and evaluating care plans to optimize member health care.

Highlights

• Pay: $70,560 - $88,200/year
• Location: Latham, NY
• Schedule: Monday - Friday; 8:00am - 4:30pm EST, with 2-4 required evening shifts per month

What You'll Do

• Ensure member access to services appropriate to their health needs.
• Conduct assessments to identify individual needs and develop care management plans.
• Implement care plans by facilitating authorizations/referrals as appropriate.
• 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 care management treatment plans.
• Negotiate rates of reimbursement, as applicable.
• Assist in problem solving with providers, claims, or service issues.

Requirements

Education

• BA/BS in a health-related field required

Experience

• Minimum of 3 years of clinical experience required

Licenses & Certifications

• Current, unrestricted RN license in applicable state(s) required
• Multi-state licensure required if providing services in multiple states
• Certification as a Case Manager preferred

Benefits

• Comprehensive benefits package
• Incentive and recognition programs
• Equity stock purchase and 401k contribution

About Elevance Health

Elevance Health is a health company dedicated to improving lives and communities – and making healthcare simpler. They are a Fortune 25 company with a longstanding history in the healthcare industry, looking for leaders at all levels who are passionate about making an impact on their members and the communities they serve.