Remote RN Case Manager II — Care Coordination Lead

Elevance Health, Inc.; Louisville (KY); Hybrid; USD 70,000 - 100,000; Full time

Benefits offered by this job

merit increases

paid holidays

Paid Time Off

incentive bonus programs

medical

dental

vision

short and long term disability

Job summary

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

The role involves telephonic care management, assessments, and coordinating care across the continuum, with required in-person training sessions and KY residency. Responsibilities include ensuring access to services, developing care plans, coordinating authorizations/referrals, and collaborating with Medical Directors.

Qualifications

• Requires BA/BS in a health-related field and minimum of 5 years of clinical experience.
• Current, unrestricted RN license in KY 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 need.
• Conducts assessments to identify individual needs and a specific care management plan to address objectives and goals as identified during assessment.
• Implement 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.
• Assists in problem solving with providers, claims or service issues.
• Assists with development of utilization/care management policies and procedures.

Skills

Care management

Assessment

Coordination

Problem solving

Education

BA/BS in a health-related field

Job description

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

The role involves telephonic care management, assessments, and coordinating care across the continuum, with required in-person training sessions and KY residency. Responsibilities include ensuring access to services, developing care plans, coordinating authorizations/referrals, and collaborating with Medical Directors.