Remote Nurse Case Manager II - Complex Care & Coordination

Elevance Health; New York (NY); À distance; USD 76 000 - 119 000; Plein temps

Avantages offerts par ce poste

Comprehensive benefits package

Incentive and recognition programs

Equity stock purchase and 401k

Résumé du poste

Elevance Health in the United States seeks a Telephonic Nurse Case Manager II to oversee care management for members with complex and chronic care needs, focusing on assessing, developing, implementing, coordinating, monitoring, and evaluating care plans in a flexible, virtual role.

The role requires a BA/BS in a health-related field, a current RN license, and at least 5 years of clinical experience, including acute care; multi-state licensure is preferred.

Qualifications

• BA/BS in a health-related field is required.
• RN license in applicable state required; multi-state licensure if providing services in multiple states.
• Certification as a Case Manager is preferred.

Responsabilités

• Ensure member access to services appropriate to their health needs
• Conduct assessments to identify individual needs and develop care management plans
• Implement care plans by facilitating authorizations/referrals as appropriate
• Coordinate internal and external resources to meet identified needs
• Monitor and evaluate the effectiveness of care management plans and modify as necessary
• Interface with Medical Directors and Physician Advisors on treatment plans
• Negotiate rates of reimbursement, as applicable
• Assist in problem solving with providers, claims, or service issues
• Assist with the development of utilization/care management policies and procedures

Formation

BA/BS in a health-related field

Description du poste

Elevance Health in the United States seeks a Telephonic Nurse Case Manager II to oversee care management for members with complex and chronic care needs, focusing on assessing, developing, implementing, coordinating, monitoring, and evaluating care plans in a flexible, virtual role.

The role requires a BA/BS in a health-related field, a current RN license, and at least 5 years of clinical experience, including acute care; multi-state licensure is preferred.