Nurse Case Mgr II

IntelliResume; Denver (CO); On-site; USD 79,000 - 131,000; Full time

Benefits offered by this job

Comprehensive benefits package

Incentive and recognition programs

Equity stock purchase and 401k

Job summary

Elevance Health is seeking a Telephonic Nurse Case Manager II in Denver, CO to lead care management for members with complex and chronic needs. You will assess, plan, implement, coordinate, monitor, and evaluate care to optimize health outcomes.

Requirements include a BA/BS in a health-related field, at least 5 years of clinical experience (acute care preferred), and an unrestricted RN license with multi-state licensure. The role offers a comprehensive benefits package and a $2000 sign-on bonus.

Qualifications

• BA/BS in a health-related field required.
• Minimum 5 years of clinical experience required.
• Multi-state licensure required for services in multiple states; RN license active.

Responsibilities

• Ensure member access to services appropriate to health needs.
• Conduct assessments to identify needs and develop care management plans.
• Implement care plans via authorizations/referrals as appropriate.
• Coordinate internal and external resources to meet needs.
• Monitor and evaluate care plans; modify as necessary.
• Interface with Medical Directors and Physician Advisors on 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.

Skills

Care coordination

Assessments

Communication with providers

Utilization management

Education

BA/BS in health field

Tools

Case management software

Job description

About This Role

The Telephonic Nurse Case Manager II is responsible for 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: $79,464 to $130,548
• Location: Denver, CO
• Sign-On Bonus: $2000
• Schedule: Full-time, Monday - Friday 9:00am to 5:30pm with 1-2 late evenings

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:

• BA/BS in a health-related field required

Experience:

• Minimum of 5 years of clinical experience required
• Preferred: 2 years’ experience in an acute care setting

Licenses & Certifications:

• Current, unrestricted RN license in applicable state(s) required
• Multi-state licensure required for 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.