Nurse Case Mgr II

IntelliResume; Kentucky; On-site; USD 70,000 - 90,000; Full time

Benefits offered by this job

Merit increases

Paid holidays

Paid Time Off

Incentive bonus programs

Medical benefits

Dental benefits

Vision benefits

Disability benefits

401(k) + match

Stock purchase plan

Life insurance

Wellness programs

Financial education resources

Job summary

Elevance Health is seeking a Nurse Case Manager II in Louisville, KY. This full-time position focuses on care management for members with complex health needs. Responsibilities include conducting assessments, implementing care plans, and coordinating resources.

The ideal candidate will have a current RN license and at least 2 years of experience in acute care. This role also offers various benefits, including medical, dental, and vision coverage, along with merit increases and paid time off.

Qualifications

• Current, unrestricted RN license required.
• Minimum 2 years’ experience in an acute care setting.
• Case Management and Utilization Management experience preferred.

Responsibilities

• Ensure member access to services appropriate to their health needs.
• Conduct assessments to identify individual needs.
• Implement care plans by facilitating authorizations/referrals.
• Coordinate internal and external resources to meet needs.
• Monitor and evaluate care management plans.
• Interface with Medical Directors and Physician Advisors.
• Negotiate rates of reimbursement as applicable.
• Assist in problem-solving with providers or claims.

Skills

Care management

Assessment

Coordination

Monitoring

Negotiation

Education

Current RN license

Job description

About This Role

The 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

• Location: Louisville, KY
• 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

• 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 communities.