Remote Nurse Case Manager I | Telephonic Care Coordination

Elevance Health, Inc.; Richmond (VA); Híbrido; USD 67.000 - 116.000; Jornada completa

Descripción de la vacante

Elevance Health is seeking a Telephonic Nurse Case Manager I to manage care for members with complex and chronic needs, conducting telephonic assessments, developing and coordinating comprehensive care plans, and coordinating authorizations and referrals across the care continuum.

The role supports a virtual full-time schedule with required in-person training and possible alternate locations within reasonable commuting distance. Multi-state licensure is required for multi-state service delivery.

Formación

• Requires BA/BS in a health-related field and a 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.

Responsabilidades

• 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.

Conocimientos

Nurse case management

Telephonic care management

Multi-state licensure

Clinical assessment

Educación

BA/BS in health-related field

Descripción del empleo

Elevance Health is seeking a Telephonic Nurse Case Manager I to manage care for members with complex and chronic needs, conducting telephonic assessments, developing and coordinating comprehensive care plans, and coordinating authorizations and referrals across the care continuum.

The role supports a virtual full-time schedule with required in-person training and possible alternate locations within reasonable commuting distance. Multi-state licensure is required for multi-state service delivery.