Remote Nurse Case Manager I — Care Coordination

Elevance Health, Inc.; Latham (NY); Hybride; USD 71 000 - 111 000; Plein temps

Résumé du poste

Elevance Health, Inc. is seeking a Nurse Case Manager I to support care management for members with complex needs, assessing, developing, implementing, coordinating, and evaluating care plans. Some on-site activity may be required for discharge planning and training.

The role is hybrid/virtual with in-person onboarding and occasional site visits. Requires RN licensure, a BA/BS in health-related field, and 3 years of clinical experience, with multi-state licensure preferred.

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.

Responsabilités

• Ensures member access to services appropriate to health needs.
• Conducts assessments to identify needs and a care management plan.
• Implement care plan by facilitating authorizations/referrals within benefits structure or via 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 care management treatment plans.
• Negotiates rates of reimbursement, as applicable.
• Assists in problem solving with providers, claims or service issues.

Connaissances

Assessment skills

Care coordination

Discharge planning

Formation

BA/BS in health-related field

RN license (unrestricted) in applicable state(s)

Multi-state licensure (if applying across states)

Description du poste

Elevance Health, Inc. is seeking a Nurse Case Manager I to support care management for members with complex needs, assessing, developing, implementing, coordinating, and evaluating care plans. Some on-site activity may be required for discharge planning and training.

The role is hybrid/virtual with in-person onboarding and occasional site visits. Requires RN licensure, a BA/BS in health-related field, and 3 years of clinical experience, with multi-state licensure preferred.