Remote Nurse Case Manager II - Care Coordination

Elevance Health; Boght Corners (NY); Hybrid; USD 79,000 - 119,000; Full time

Job summary

Elevance Health is seeking a Nurse Case Manager II in New York. The role entails performing care management for members with complex and chronic needs, assessing, developing, coordinating, implementing, and evaluating care plans.

Work is conducted telephonically or on-site, including hospital discharge planning, with a hybrid/virtual work model. Minimum requirements include a BA/BS in a health-related field and at least 5 years of clinical experience, plus an unrestricted RN license (multi-state

Qualifications

• Requires BA/BS in a health related field and minimum of 5 years of clinical experience; or any combination of education and experience, which would provide 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 and develops care management plans.
• Implements care plans by facilitating authorizations/referrals 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 adjusts as needed.
• Interfaces with Medical Directors and Physician Advisors on care management plans.
• Negotiates rates of reimbursement, as applicable.
• Assists in problem solving with providers, claims or service issues.
• Supports development of utilization/care management policies and procedures

Skills

Care coordination

Discharge planning

Clinical judgment

Education

BA/BS in health-related field

RN license

Job description

Elevance Health is seeking a Nurse Case Manager II in New York. The role entails performing care management for members with complex and chronic needs, assessing, developing, coordinating, implementing, and evaluating care plans.

Work is conducted telephonically or on-site, including hospital discharge planning, with a hybrid/virtual work model. Minimum requirements include a BA/BS in a health-related field and at least 5 years of clinical experience, plus an unrestricted RN license (multi-state