Remote RN Telephonic Case Manager II

Elevance Health, Inc.; Wilmington (DE); Hybrid; USD 90,000 - 110,000; Full time

Job summary

Elevance Health is seeking a Telephonic Nurse Case Manager II to coordinate care plans for members with complex needs. This role operates telephonically with required in-person trainings, offering flexibility and autonomy. Hybrid work is available within commuting distance as part of Elevance Health's program.

Ideal candidates hold a BA/BS in a health-related field and an active RN license, with at least 5 years of clinical experience and multi-state licensure to support cross-state servicing.

Qualifications

• Requires BA/BS in a health related field and minimum of 5 years of clinical experience.
• 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 to identify individual needs and a specific care management plan to address objectives and goals as identified during assessment.
• Implements 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.
• Negotiates rates of reimbursement, as applicable.
• Assists in problem solving with providers, claims or service issues.
• Assists with development of utilization/care management policies and procedures.

Skills

Case management experience

Critical thinking

Communication

Time management

Multitasking

Telephonic care management

Education

BA/BS in health-related field

RN license

Tools

Microsoft Office

Job description

Elevance Health is seeking a Telephonic Nurse Case Manager II to coordinate care plans for members with complex needs. This role operates telephonically with required in-person trainings, offering flexibility and autonomy. Hybrid work is available within commuting distance as part of Elevance Health's program.

Ideal candidates hold a BA/BS in a health-related field and an active RN license, with at least 5 years of clinical experience and multi-state licensure to support cross-state servicing.