Remote Nurse Case Manager II — Expert Care Coordinator

Elevance Health (Anthem); Boght Corners (NY); Hybrid; USD 76,000 - 119,000; Full time

Benefits offered by this job

Comprehensive benefits package

Equity stock purchase program

401k contribution

Job summary

Elevance Health is seeking a Nurse Case Manager II to provide telephonic care management for members with complex and chronic needs. The role involves assessing, developing, coordinating, monitoring, and evaluating care plans across the care continuum with in-person training when required.

The candidate must hold a BA/BS in a health-related field, an active RN license, and at least five years of clinical experience.

Qualifications

• Requires BA/BS in a health-related field.
• Current, unrestricted RN license in applicable state(s).
• Multi-state licensure is required if providing services in multiple states.
• Certification as a Case Manager is preferred.

Responsibilities

• Ensures member access to services appropriate to their health needs.
• Conducts assessments to identify individual needs and develop a care management plan.
• Implements care plan by facilitating authorizations/referrals within benefits structure.
• Coordinates internal and external resources to meet identified needs.
• Monitors and evaluates the effectiveness of the care management plan and modifies as necessary.
• Interfacing with Medical Directors and Physician Advisors on care management plans.
• Negotiates reimbursement rates as applicable.
• Assists in problem solving with providers, claims, or service issues.
• Assists with development of utilization/care management policies and procedures.

Skills

RN license

Case management

Clinical experience

Multi-state licensure

Certification preferred

EST/CST zones

Education

BA/BS in health-related field

Job description

Elevance Health is seeking a Nurse Case Manager II to provide telephonic care management for members with complex and chronic needs. The role involves assessing, developing, coordinating, monitoring, and evaluating care plans across the care continuum with in-person training when required.

The candidate must hold a BA/BS in a health-related field, an active RN license, and at least five years of clinical experience.