Nurse Case Mgr I (contract)

Elevance Health; Indianapolis (IN); Hybrid; USD 55,000 - 83,000; Full time

Job summary

Elevance Health is seeking a contract-based Care Manager to support member care in a hybrid work model. The role requires an RN license, a BA/BS, and case management certification, with multi-state licensure preferred, and 3+ years of clinical care experience.

The incumbent will assess needs, develop care plans, coordinate authorizations and referrals, collaborate with medical directors, and monitor plan effectiveness while navigating reimbursement discussions.

Qualifications

• BA/BS and 3 years of clinical care experience; or equivalent background.
• Current and active RN license in applicable state(s).
• Multi-state licensure is required if providing services in multiple states.
• Certification as a Case Manager and BS in health/human services preferred.

Responsibilities

• Ensures member access to services appropriate to health needs.
• Conducts assessments and develops care management plans.
• Implements care plans via authorizations/referrals within benefits or through arrangements.
• Coordinates internal and external resources to meet needs.
• Monitors and evaluates plan effectiveness and updates as necessary.
• Interfaces with Medical Directors and Physician Advisors on treatment plans.
• Negotiates rates of reimbursement when applicable.
• Assists in problem solving with providers, claims or service issues.

Skills

RN license

Case management

Clinical care experience

Education

BA/BS in health or human services

RN licensure (licensure)

Job description

Please note this is the target date and is subject to change. BCForward will send official notice ahead of a confirmed start date.

Primary duties may include, but are not limited to:

Ensures member access to services appropriate to their health needs.

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.

Requirements:

For URAC accredited areas the following applies: Requires BA/BS and 3 years of clinical care experience; or any combination of education and experience, which would provide an equivalent background.

Current and active RN license required in applicable state(s).

Multi-state licensure is required if this individual is providing services in multiple states.

Certification as a Case Manager and a BS in a health or human services related field preferred.

Work from home

Elevance Health operates in a Hybrid Workforce Strategy. Unless specified as primarily virtual by the hiring manager, contractors are required to work at an Elevance Health location at least once per week, and potentially several times per week. Specific requirements and expectations for time onsite will be discussed as part of the hiring process. Candidates must be within a reasonable commute to a PulsePoint location.

Job Type: Contract

About BCForward:

Founded in 1998 on the idea that industry leaders needed a professional service, and workforce management expert, to fuel the development and execution of core business and technology strategies, BCforward is a Black-owned firm providing unique solutions supporting value capture and digital product delivery needs for organizations around the world. Headquartered in Indianapolis, IN with an Offshore Development Center in Hyderabad, India, BCforward's 6,000 consultants support more than 225 clients globally.

BCforward champions the power of human potential to help companies transform, accelerate, and scale. Guided by our core values of People-Centric, Optimism, Excellence, Diversity, and Accountability, our professionals have helped our clients achieve their strategic goals for more than 25 years. Our strong culture and clear values have enabled BCforward to become a market leader and best in class place to work.

BCForward is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, or protected veteran status and will not be discriminated against based on disability.

To learn more about how BCforward collects and uses personal information as part of the recruiting process, view our Privacy Notice and CCPA Addendum. As part of the recruitment process, we may ask for you to disclose and provide us with various categories of personal information, including identifiers, professional information, commercial information, education information, and other related information. BCforward will only use this information to complete the recruitment process.

This posting is not an offer of employment. All applicants applying for positions in the United States must be legally authorized to work in the United States. The submission of intentionally false or fraudulent information in response to this posting may render the applicant ineligible for the position. Any subsequent offer of employment will be considered employment at-will regardless of the anticipated assignment duration.

Benefits Information

BCForward offers all eligible employees a comprehensive benefits package including, but not limited to major medical, HSA, dental, vision, employer-provided group life, voluntary life insurance, short-term disability, long-term disability, and 401k.

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. This does not encompass additional non-standard compensation (e.g., benefits, paid time off, per diem, etc.).

Elevance Health is a health company dedicated to improving lives and communities – and making healthcare simpler. We are a Fortune 25 company with a longstanding history in the healthcare industry, looking for leaders at all levels of the organization who are passionate about making an impact on our members and the communities we serve.