Nurse Case Manager Lead

Elevance Health, Inc.; Louisville (KY); Hybrid; USD 90,000 - 134,000; Full time

Benefits offered by this job

Sign-on bonus

Job summary

Elevance Health, Inc. is seeking a Telephonic Nurse Case Manager Lead in Louisville, KY to oversee care management for members with complex needs and coordinate care plans across the care continuum.

This role involves telephonic and on-site duties, including collaboration with Medical Directors and staff to ensure timely access to services. Applicants should have a BA/BS in a health-related field, an active RN license, and case management certification within 3 years.

Qualifications

• Requires a BA/BS in a health related field and 5 years of clinical experience.
• Current, unrestricted RN license in applicable state(s) required.
• Case manager certification required within 3 years of starting in this role.
• Preferred: Certification as a Case Manager.
• BS in a health or human services related field preferred.
• Managed care experience necessary.
• Case management experience a plus.

Responsibilities

• Handles care management for members with complex and chronic needs by assessing and developing care plans.
• Implements care plans and coordinates referrals within benefits structure or through extra-contractual arrangements.
• Coordinates internal and external resources to meet identified needs.
• Monitors and evaluates care management effectiveness and adapts as needed.
• Interacts with Medical Directors and Physician Advisors on treatment plans.
• May participate in policy development and audits; supports day-to-day workflow.

Skills

RN license

Case management

Clinical experience

Certification within 3 years

Education

BA/BS in health related field

Job description

Sign on Bonus: $3000.

Alternate locations may be considered if candidates reside within a commuting distance from an office.

Please note that per our policy on hybrid/virtual work, candidates not within a reasonable commuting distance from the posting location(s) will not be considered for employment, unless an accommodation is granted as required by law.

Hours: Monday - Friday, 11:30- 8 pm EST.

Telephonic Nurse Case Manager Lead

The Telephonic Nurse Case Manager Lead is responsible for care management within the scope of licensure for members with complex and chronic care needs by assessing, developing, implementing, coordinating, monitoring, and evaluating care plans designed to optimize member health care across the care continuum and ensuring member access to services appropriate to their health needs. Performs duties telephonically or on-site such as at hospitals for discharge planning.

How You Will Make An Impact

• Conducts assessments to identify individual needs and a specific care management plan to address objectives and goals as identified during assessment.
• Implements care plan by facilitating authorizations/referrals as appropriate within benefits structure or through extra-contractual arrangements.
• Coordinates internal and external resources to meet identified needs.
• Monitors and evaluates effectiveness of the care management plan and modifies as necessary.
• Interfaces with Medical Directors and Physician Advisors on the development of care management treatment plans.
• Negotiates rates of reimbursement, as applicable.
• Assists in problem solving with providers, claims or service issues.
• Assists with development of utilization/care management policies and procedures, chairs and schedules meetings, as well as presents cases for discussion at Grand Rounds/Care Conferences and participates in interdepartmental and/or cross brand workgroups.
• May require the development of a focused skill set including comprehensive knowledge of specific disease process or traumatic injury and functions as preceptor for new care management staff.
• Participates in audit activities and assists supervisor with management of day-to-day activities, such as monitoring and prioritizing workflow, delivering constructive coaching and feedback, and developing associated corrective action plans at direction of the manager.
• Serves as first line contact for conflict resolution.
• Develops training materials, completes quality audits, performs process evaluations, and tests and monitors systems/process enhancements.

Minimum Requirements

• Requires a BA/BS in a health related field and 5 years of clinical experience; or any combination of education and experience, which would provide an equivalent background.
• Current, unrestricted RN license in applicable state(s) required.
• Case manager certification required within 3 years of starting in this role.

Preferred Skills, Capabilities, And Experiences

• Certification as a Case Manager is preferred.
• BS in a health or human services related field preferred.
• Managed care experience necessary..
• Case management experience a plus.

For candidates working in person or virtually in the below locations, the salary* range for this specific position is $89,520 to $134,280.

Locations: Virginia.

In addition to your salary, Elevance Health offers benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements).

The salary offered for this specific position is based on a number of legitimate, non-discriminatory factors set by the Company. The Company is fully committed to ensuring equal pay opportunities for equal work regardless of gender, race, or any other category protected by federal, state, and local pay equity laws.

• The salary range is the range Elevance Health in good faith believes is the range of possible compensation for this role at the time of this posting. This range may be modified in the future and actual compensation may vary from posting based on geographic location, work experience, education and/or skill level. Even within the range, the actual compensation will vary depending on the above factors as well as market/business considerations. No amount is considered to be wages or compensation until such amount is earned, vested, and determinable under the terms and conditions of the applicable policies and plans. The amount and availability of any bonus, commission, benefits, or any other form of compensation and benefits that are allocable to a particular employee remains in the Company's sole discretion unless and until paid and may be modified at the Company’s sole discretion, consistent with the law.