Nurse Case Mgr II (US)

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

401k contribution

Job summary

Elevance Health in New York is seeking a Nurse Case Manager II to perform care management for members with complex and chronic needs, assessing, developing, coordinating, monitoring and evaluating care plans to optimize health outcomes.

Based in Latham, NY, this full-time role offers a competitive salary with comprehensive benefits and collaboration with Medical Directors and providers to improve utilization and care policies.

Qualifications

• BA/BS in health-related field is required.
• Active, unrestricted RN license in applicable state(s) required; multi-state licensure preferred.
• Certification as a Case Manager is a plus.

Responsibilities

• Ensure member access to services appropriate to health needs.
• Conduct assessments to identify needs and develop care plans.
• Implement care plans via authorizations/referrals as needed.
• Coordinate internal and external resources to meet needs.
• Monitor and evaluate care management plan effectiveness and adjust as needed.
• Interface with Medical Directors and Physician Advisors on care plans.
• Negotiate rates of reimbursement as applicable.
• Assist with problem-solving with providers, claims, or service issues.
• Help develop utilization/care management policies and procedures.

Skills

Care management

Assessment & care planning

Interpersonal communication

Education

BA/BS in health-related field

Current, unrestricted RN license in applicable state(s)

Multistate licensure

Certification as a Case Manager (preferred)

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 those who excel in assessing, developing, implementing, coordinating, monitoring, and evaluating care plans to optimize member health care.

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 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

• Comprehensive benefits package
• Incentive and recognition programs
• Equity stock purchase
• 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.