Nurse Case Mgr II (US)

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, dental, and vision benefits

Short and long-term disability

401(k) + match

Stock purchase plan

Life insurance

Wellness programs

Financial education resources

Job summary

Elevance Health is seeking a Nurse Case Manager II to perform care management for members with complex and chronic needs in Louisville, KY. This role requires strong clinical experience and the ability to assess, develop, implement, coordinate, monitor, and evaluate care plans.

The position is full-time with evening shift 11:30 AM – 8:00 PM, offering a comprehensive benefits package and opportunities to collaborate with Medical Directors and providers.

Qualifications

• BA/BS in a health-related field is required.
• Minimum of 5 years of clinical experience is required.
• Current, unrestricted RN license in applicable state(s) required.
• Multi-state licensure required if providing services in multiple states.
• Certification as a Case Manager is preferred.

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.
• Assist with the development of utilization/care management policies and procedures.

Skills

RN license

Case management

Clinical experience

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. This role is ideal for individuals with strong clinical experience who can assess, develop, implement, coordinate, monitor, and evaluate care plans.

Highlights

• Location: Louisville, KY


• Schedule: Full-time, 11:30 AM - 8:00 PM


• Department/Unit: Care Management

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

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

• 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 the communities they serve.