Remote Nurse Case Manager I - Care Coordination

Elevance Health, Inc.; St. Louis (MO); Remote; USD 65,000 - 85,000; Full time

Job summary

Elevance Health, Inc. Nurse Case Manager I role involves performing care management for members with complex and chronic needs by assessing, developing, implementing, coordinating, monitoring, and evaluating care plans designed to optimize health care across the care continuum.

Duties include telephonic and on-site discharge planning. The position supports a hybrid/remote work model with in-person onboarding and training sessions as required.

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 this individual is 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 to address objectives and goals as identified during assessment.
• Implements care plan by facilitating authorizations/referrals as appropriate within benefits structure or through 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 the development of care management treatment plans.
• Negotiates rates of reimbursement, as applicable.
• Assists in problem solving with providers, claims or service issues.

Skills

RN license

Multi-state licensure

Case management certification

Education

BA/BS in health-related field

BS in health/human services preferred

Job description

Elevance Health, Inc. Nurse Case Manager I role involves performing care management for members with complex and chronic needs by assessing, developing, implementing, coordinating, monitoring, and evaluating care plans designed to optimize health care across the care continuum.

Duties include telephonic and on-site discharge planning. The position supports a hybrid/remote work model with in-person onboarding and training sessions as required.