Remote Telephonic Nurse Case Manager

Elevance Health; Latham (NY); Hybrid; USD 67,000 - 116,000; Full time

Job summary

Elevance Health is seeking a Telephonic Nurse Case Manager I to perform care management for members with complex and chronic needs, telephonically and within licensure scope. The role requires multi-state licensure, a BA/BS in a health-related field, and an RN license, with in-person training sessions and occasional in-office requirements.

The position operates on a hybrid/virtual model with a Monday–Friday schedule and some evenings per month.

Qualifications

• Requires BA/BS in a health related field and minimum of 3 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.

Skills

Case management

RN license

Multi-state licensure

Oncology experience

Case management certification

Education

BA/BS in health-related field

Job description

Elevance Health is seeking a Telephonic Nurse Case Manager I to perform care management for members with complex and chronic needs, telephonically and within licensure scope. The role requires multi-state licensure, a BA/BS in a health-related field, and an RN license, with in-person training sessions and occasional in-office requirements.

The position operates on a hybrid/virtual model with a Monday–Friday schedule and some evenings per month.