Remote Nurse Case Manager I – Care Coordination

Elevance Health (Anthem)

Boght Corners (NY)

Hybrid

USD 71,000 - 106,000

Full time

3 days ago

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Job summary

Elevance Health in New York is seeking a Nurse Case Manager I to perform care management for members with complex and chronic needs. The role involves assessing, developing, coordinating, and evaluating care plans, either telephonically or on-site, including discharge planning at hospitals.

Requires a BA/BS in a health-related field, 3+ years clinical experience, and an active RN license. The position offers a salary range for NY and comprehensive benefits, with hybrid/virtual work options and

Qualifications

Requires BA/BS in a health-related field and minimum of 3 years of clinical experience.
Current, unrestricted RN license in applicable state(s) required.
Multi-state licensure is required if providing services in multiple states.

Responsibilities

Ensures member access to services appropriate to their health needs.
Conducts assessments to identify individual needs and a specific care management plan.
Implements care plan by facilitating authorizations/referrals within benefits or extra-contractual arrangements.
Coordinates internal and external resources to meet identified needs.
Monitors and evaluates effectiveness of the care management plan and modifies as necessary.
Interfaces with Medical Directors and Physician Advisors on treatment plan development.
Negotiates rates of reimbursement, as applicable.
Assists in problem solving with providers, claims or service issues.