Nurse Case Mgr I (US)

Elevance Health; Connecticut; Hybrid; USD 71,000 - 111,000; Full time

Benefits offered by this job

Comprehensive benefits package

Incentive and recognition programs

Equity stock purchase and 401k_contrib

Job summary

Elevance Health is seeking a Nurse Case Manager I in Wallingford, CT. This full-time role combines virtual work with in-person training sessions to coordinate and manage care plans for members with complex needs.

You will assess, develop, implement, and monitor care plans, interfacing with Medical Directors and Providers to ensure optimal member care and appropriate authorizations. A RN license and 3+ years of clinical experience are required.

Qualifications

• BA/BS in a health-related field required.
• Minimum of 3 years of clinical experience required.
• RN license in applicable state(s) required; multi-state licensure may be required.

Responsibilities

• 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.

Skills

Care coordination

Assessment

Care plan development

Education

BA/BS in a health-related field

Job description

About This Role

The Nurse Case Manager I will perform care management for members with complex and chronic care needs, focusing on assessing, developing, implementing, coordinating, monitoring, and evaluating care plans to optimize member health care.

Highlights

• Pay: $70,560 - $110,880/year
• Location: Wallingford, CT
• Schedule: Full-time, Virtual with in-person training sessions

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

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.