Nurse Case Manager II

Elevance Health; Colorado; On-site; USD 79,000 - 125,000; Full time

Benefits offered by this job

Comprehensive benefits package

Equity stock purchase

401k contribution

Job summary

Elevance Health is seeking a Nurse Case Manager II in Denver, CO. The role focuses on assessing, developing, implementing, coordinating, monitoring, and evaluating care plans for members with complex and chronic needs to optimize health outcomes.

Responsibilities include collaborating with Medical Directors, facilitating authorizations/referrals, coordinating resources, and contributing to policy development. The position offers full-time scheduling and a strong benefits package.

Qualifications

• BA/BS in health-related field required.
• Minimum of 5 years of clinical experience required.
• Current, unrestricted RN license in applicable state(s) required; multi-state licensure should be in place if serving multiple states.
• Certification as a Case Manager preferred.

Responsibilities

• Assess individual member needs and develop care management plans.
• Implement care plans by facilitating authorizations/referrals.
• Coordinate internal and external resources to meet identified needs.
• Monitor and evaluate the effectiveness of care management plans.
• Interface with Medical Directors and Physician Advisors on treatment plans.
• Negotiate rates of reimbursement as applicable.
• Assist in problem-solving with providers, claims, or service issues.
• Contribute to the development of utilization/care management policies and procedures.

Skills

Care coordination

Clinical assessment

Interdisciplinary collaboration

Communication

Education

BA/BS in health-related field

Job description

About This Role

The Nurse Case Manager II is responsible for 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: $79,464 - $124,872/year
• Location: Denver, CO
• Schedule: Full-time, Monday-Friday, 10 - 6:30 pm EST

What You'll Do

• Assess individual needs and develop specific care management plans.
• Implement care plans by facilitating authorizations/referrals.
• Coordinate internal and external resources to meet identified needs.
• Monitor and evaluate the effectiveness of care management plans.
• Interface with Medical Directors and Physician Advisors on treatment plans.
• Negotiate rates of reimbursement as applicable.
• Assist in problem-solving with providers, claims, or service issues.
• Contribute to the development of utilization/care management policies and procedures.

Requirements

• Education:
  • BA/BS in a health-related field required
• Experience:
  • Minimum of 5 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.