Remote RN Case Manager II - Flexible Care Leadership

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

Benefits offered by this job

Benefits package

Equity stock purchase plan

401k contributions

Job summary

Elevance Health in New York is seeking a Nurse Case Manager II (US) to perform care management for members with complex and chronic needs, assessing, developing, implementing, coordinating, monitoring and evaluating care plans across the care continuum. This role may involve telephonic or on-site work, including discharge planning in hospitals.

The position requires a BA/BS in a health-related field and a current, unrestricted RN license in the applicable state(s), with multi-state licensure

Qualifications

• Requires BA/BS in a health related field and minimum of 5 years of clinical experience or equivalent background.
• Current, unrestricted RN license in applicable state(s) required.
• Multi-state licensure required if providing services in multiple states.

Responsibilities

• Ensures member access to services and conducts assessments to identify needs and goals.
• Implements care plan by facilitating authorizations/referrals within benefits or 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.
• Interacts with Medical Directors and Physician Advisors on care plans.
• Negotiates rates of reimbursement, as applicable.
• Assists with problem solving with providers, claims or service issues.
• Contributes to development of utilization/care management policies and procedures.

Skills

RN license

5+ years clinical experience

Case management

Multi-state licensure

Communication skills

Education

BA/BS in health related field

BS in health or human services related field preferred

Job description

Elevance Health in New York is seeking a Nurse Case Manager II (US) to perform care management for members with complex and chronic needs, assessing, developing, implementing, coordinating, monitoring and evaluating care plans across the care continuum. This role may involve telephonic or on-site work, including discharge planning in hospitals.

The position requires a BA/BS in a health-related field and a current, unrestricted RN license in the applicable state(s), with multi-state licensure