Nurse Case Manager II

IntelliResume; Georgia; On-site; USD 85,000 - 115,000; Full time

Benefits offered by this job

401(k) with match

Stock purchase plan

Medical, dental, and vision benefits

Paid holidays and PTO

Disability benefits

Wellness programs

Life insurance

Job summary

Elevance Health, based in Atlanta, GA, seeks a Nurse Case Manager II to oversee care management for members with complex and chronic needs. You will assess, develop, implement, coordinate, monitor, and evaluate care plans to optimize health outcomes.

The role requires a BA/BS in a health-related field, an active RN license, and multi-state licensure if applicable. A Case Manager certification is preferred. This full-time position includes EST hours and collaboration with medical leadership.

Qualifications

• BA/BS in a health-related field required.
• Minimum of 5 years of clinical experience required.
• Current, unrestricted RN license in applicable home state required.
• Multi-state licensure required if providing services in multiple states.
• Certification as a Case Manager preferred.

Responsibilities

• 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.
• Assist with the development of utilization/care management policies and procedures.

Skills

Care management

Interdisciplinary collaboration

Communication skills

Problem solving

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

• Location: Atlanta, GA
• Schedule: Full-time, Monday-Friday EST, with 1 late evening per week

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.
• Assist with 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 home state required
• Multi-state licensure required if providing services in multiple states
• Certification as a Case Manager preferred

Benefits

• Merit increases
• Paid holidays and Paid Time Off
• Medical, dental, and vision benefits
• Short and long-term disability benefits
• 401(k) with match
• Stock purchase plan
• Life insurance
• Wellness programs and financial education resources

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.