Nurse Case Mgr I

IntelliResume; Missouri; On-site; USD 65,000 - 90,000; Full time

Benefits offered by this job

Medical, dental, and vision benefits

401(k) + match

Paid Time Off

Merit increases

Paid holidays

Stock purchase plan

Job summary

Elevance Health is seeking a Nurse Case Manager I in St. Louis, MO to perform care management for members with complex and chronic needs.

You will assess, develop, implement, coordinate, monitor, and evaluate care plans in a flexible work environment focused on optimizing member healthcare. Ideal candidates will hold an RN license, have at least 3 years of clinical experience, and be capable of coordinating internal and external resources.

Qualifications

• BA/BS in a health-related field required.
• Minimum of 3 years of clinical experience required.
• Current, unrestricted RN license in applicable state(s) required.
• Multi-state licensure required if providing services in multiple states.
• Certification as a Case Manager preferred.
• BS in a health or human services related field preferred.

Responsibilities

• Ensure member access to services appropriate to health needs.
• Conduct assessments to identify 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 effectiveness of care management plans and modify as necessary.
• Interface with Medical Directors and Physician Advisors on care plans.
• Negotiate rates of reimbursement, as applicable.
• Assist in problem solving with providers, claims, or service issues.

Skills

Care coordination

Assessment skills

Education

BA/BS in a health-related field

BS in a health or human services related field

Job description

About This Role

The Nurse Case Manager I is responsible for performing care management for members with complex and chronic care needs by assessing, developing, implementing, coordinating, monitoring, and evaluating care plans. This role is ideal for individuals who thrive in a flexible work environment and are passionate about optimizing member healthcare.

Highlights

• Location: St. Louis, MO
• Schedule: Full-time, M-F 10:30am-7:30pm CST

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.

Requirements

Education:

• BA/BS in a health-related field required

Experience:

• Minimum of 3 years of clinical experience required

Licenses & Certifications:

• Current, unrestricted RN license in applicable state(s) required
• Multi-state licensure required if providing services in multiple states
• Certification as a Case Manager preferred
• BS in a health or human services related field preferred

Benefits

• Merit increases
• Paid holidays
• Paid Time Off
• Incentive bonus programs
• Medical, dental, and vision benefits
• Short and long-term disability benefits
• 401(k) + match
• Stock purchase plan
• Life insurance
• Wellness programs
• 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.