Nurse Case Mgr

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

About This Role

The Nurse Case Manager II is responsible for care management for members with complex and chronic care needs. This role is ideal for individuals who can assess, develop, implement, coordinate, monitor, and evaluate care plans to optimize member healthcare.

Highlights

• Pay: $75,680 - $124,872/year
• Location: Latham, NY
• Schedule: Full-time, M-F 9:30 AM-6:30 PM EST

What You'll Do

• Ensure member access to services appropriate to their health needs.
• 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 care management 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:

• Current, unrestricted RN license in applicable state required.

Experience:

• Minimum 2 years’ experience in an acute care setting.
• Case Management experience preferred.
• Utilization Management experience preferred.

Licenses & Certifications:

• 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
• 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.