Nurse Case Mgr II

IntelliResume; New York (NY); On-site; USD 79,000 - 119,000; 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 Nurse Case Manager II to perform care management for members with complex and chronic needs. This role supports flexibility and autonomy in a virtual work environment and is based in Latham, NY.

You will assess, develop, implement, coordinate, monitor, and evaluate care plans, interfacing with Medical Directors and Physician Advisors. Responsibilities include authorizations/referrals, resource coordination, and policy development.

Qualifications

• BA/BS in a health-related field.
• Minimum of 5 years of clinical experience.
• Current, unrestricted RN license in applicable state(s) 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 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.

Education

BA/BS in a health-related field

Job description

About This Role

The Nurse Case Manager II 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 seeking flexibility and autonomy in a virtual work environment.

Highlights

• Pay: $79,464 - $119,196/year
• Location: Latham, NY
• Schedule: Full-time, M-F 8am-4:30pm with 2-3 late evenings a month

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 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
• 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 members and communities.