Nurse Case Manager Lead

IntelliResume; Kentucky; On-site; USD 90,000 - 134,000; Full time

Benefits offered by this job

Comprehensive benefits package

Incentive and recognition programs

Equity stock purchase & 401k

Job summary

Elevance Health is seeking a Nurse Case Manager Lead for care management of members with complex and chronic care needs. The role supports telephonic and on-site care in Louisville, KY, focusing on assessing, developing, implementing, coordinating, monitoring, and evaluating care plans.

Ideal candidates have a BA/BS in a health-related field, at least 5 years of clinical experience, and an active RN license in applicable states.

Qualifications

• BA/BS in a health-related field is required.
• Minimum 5 years of clinical experience.
• Current, unrestricted RN license in applicable state(s).
• Case manager certification within 3 years of starting.

Responsibilities

• Assess patients and develop care management plans.
• Coordinate authorizations and referrals.
• Work with providers and payers to optimize care and reimbursement.
• Monitor care plans and adjust as needed.
• Collaborate with Medical Directors and Physician Advisors on treatment plans.
• Develop utilization/care management policies and procedures.
• Participate in audits and day-to-day management tasks.
• Serve as first point of contact for conflict resolution.

Skills

Care coordination

Case management

Nursing

Telephonic support

Education

BA/BS in health-related field

Job description

About This Role

The Nurse Case Manager Lead is responsible for care management of members with complex and chronic care needs, focusing on assessing, developing, implementing, coordinating, monitoring, and evaluating care plans. This role is ideal for experienced nurses looking to make a significant impact in patient care through telephonic and on-site support.

Highlights

• Pay: $89,520 - $134,280/year
• Location: Louisville, KY
• Sign-On Bonus: $3,000

What You'll Do

• 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 treatment plans.
• Negotiate rates of reimbursement as applicable.
• Assist in problem-solving with providers, claims, or service issues.
• Develop utilization/care management policies and procedures.
• Participate in audit activities and assist with day-to-day management tasks.
• Serve as the first line contact for conflict resolution.

Requirements

Education:

• BA/BS in a health-related field required

Experience:

• 5 years of clinical experience required

Licenses & Certifications:

• Current, unrestricted RN license in applicable state(s) required
• Case manager certification required within 3 years of starting in this role

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.