Remote Nurse Case Manager I: Care Coordination & Impact

Elevance Health (Anthem); Indianapolis (IN); Hybrid; USD 60,000 - 80,000; Full time

Job summary

Elevance Health is seeking a Nurse Case Manager I to perform care management for members with complex health needs. The role includes telephonic and on-site discharge planning, coordinating resources, and developing personalized care plans.

Requirements include a BA/BS in a health-related field, 3+ years of clinical experience, and an active RN license. Multistate licensure is required if working across states. Certification as a Case Manager is 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 this individual is providing services in multiple states.
• Certification as a Case Manager is preferred.

Responsibilities

• Performs care management within the scope of licensure for members with complex and chronic care needs by assessing, developing, implementing, coordinating, monitoring, and evaluating care plans.
• 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.

Education

BA/BS in a health-related field

Job description

Elevance Health is seeking a Nurse Case Manager I to perform care management for members with complex health needs. The role includes telephonic and on-site discharge planning, coordinating resources, and developing personalized care plans.

Requirements include a BA/BS in a health-related field, 3+ years of clinical experience, and an active RN license. Multistate licensure is required if working across states. Certification as a Case Manager is preferred.