Nurse Case Manager II: Care Coordination & Outcomes

Elevance Health; New York (NY); On-site; USD 76,000 - 125,000; Full time

Benefits offered by this job

Comprehensive benefits package

Equity stock purchase

401k contribution

Incentive and recognition programs

Job summary

Elevance Health in Latham, NY is seeking a Nurse Case Manager II to lead care management for members with complex and chronic needs. The role requires assessing, developing and coordinating care plans to optimize health outcomes.

You will collaborate with Medical Directors and Physicians, facilitate authorizations, monitor plan effectiveness, and advocate for appropriate services. RN licensure and acute care experience are required, with multis-state licensure preferred.

Qualifications

• Current, unrestricted RN license in applicable state required.
• Minimum 2 years’ experience in an acute care setting.
• Case Management experience preferred.
• Utilization Management experience preferred.

Responsibilities

• Ensure member access to services aligned with health needs.
• Conduct assessments to identify needs and develop care management plans.
• Implement care plans via authorizations/referrals.
• Coordinate internal and external resources to meet identified needs.
• Monitor and evaluate care management plans and adjust as needed.
• Interface with Medical Directors and Physician Advisors on care management plans.
• Negotiate rates of reimbursement, as applicable.
• Assist with problem solving with providers, claims, or service issues.
• Assist with development of utilization/care management policies and procedures.

Skills

RN licensure

Care management

Assessment

Utilization management

Coordination

Education

Registered Nurse (RN)

Job description

Elevance Health in Latham, NY is seeking a Nurse Case Manager II to lead care management for members with complex and chronic needs. The role requires assessing, developing and coordinating care plans to optimize health outcomes.

You will collaborate with Medical Directors and Physicians, facilitate authorizations, monitor plan effectiveness, and advocate for appropriate services. RN licensure and acute care experience are required, with multis-state licensure preferred.