Remote Nurse Case Manager I – Care & Discharge Planning

Elevance Health, Inc.; Latham (NY); Hybrid; USD 71,000 - 111,000; Full time

Job summary

Elevance Health, Inc. is seeking a Nurse Case Manager I to perform care management for members with complex and chronic needs.

The role entails assessing, developing, implementing, coordinating, monitoring, and evaluating care plans across the care continuum, with telephonic or on-site duties including discharge planning. Requires a BA/BS in a health-related field and a valid RN license; multi-state licensure is required if providing services in multiple states.

Qualifications

• Requires BA/BS in a health-related field and minimum 3 years of clinical experience; or an equivalent background.
• 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 develops a care management plan to address objectives and goals.
• 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

Case management certification

Education

BA/BS in health-related field

RN license

Multi-state licensure

Job description

Elevance Health, Inc. is seeking a Nurse Case Manager I to perform care management for members with complex and chronic needs.

The role entails assessing, developing, implementing, coordinating, monitoring, and evaluating care plans across the care continuum, with telephonic or on-site duties including discharge planning. Requires a BA/BS in a health-related field and a valid RN license; multi-state licensure is required if providing services in multiple states.