Remote Nurse Case Manager I — Care Coordination & Discharge

Elevance Health (Anthem); Grand Prairie (TX); À distance; USD 71 000 - 88 000; Plein temps

Avantages offerts par ce poste

Sign-on bonus

Résumé du poste

Elevance Health is seeking a Nurse Case Manager I to perform care management for members with complex and chronic needs, assessing, developing, coordinating, and evaluating care plans across the continuum. Telephonic and on-site duties may include hospital discharge planning.

Requires BA/BS in a health-related field and at least 3 years of clinical experience; RN license active in applicable states, multi-state licensure; preferred Case Manager certification.

Qualifications

• Requires BA/BS in a health-related field and minimum of 3 years of clinical experience; or any combination of education and experience providing an equivalent background.
• Current, unrestricted RN license in applicable state(s) required; multi-state licensure if providing services in multiple states.
• Certification as a Case Manager is preferred.

Responsabilités

• 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.
• 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 development of care management treatment plans.
• Negotiates rates of reimbursement, as applicable.
• Assists in problem solving with providers, claims or service issues.

Connaissances

Care management

Discharge planning

Interdisciplinary collaboration

Formation

BA/BS in health-related field

RN license (state)

Description du poste

Elevance Health is seeking a Nurse Case Manager I to perform care management for members with complex and chronic needs, assessing, developing, coordinating, and evaluating care plans across the continuum. Telephonic and on-site duties may include hospital discharge planning.

Requires BA/BS in a health-related field and at least 3 years of clinical experience; RN license active in applicable states, multi-state licensure; preferred Case Manager certification.