Remote Telephonic Nurse Case Manager I

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

Job summary

Elevance Health is seeking a Telephonic Nurse Case Manager I to perform care management within licensure for members with complex and chronic care needs, assessing, developing, implementing, coordinating, monitoring, and evaluating care plans designed to optimize health care across the care continuum, with duties conducted telephonically.

This role offers virtual full-time work with required in-person training, a Monday–Friday schedule with occasional evenings, and multi-state licensure is

Qualifications

• BA/BS in a health related field and minimum of 3 years of clinical experience.
• Current, unrestricted RN license in applicable state(s).
• Multi-state licensure is required if 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.

Education

BA/BS in a health related field

RN license

Job description

Elevance Health is seeking a Telephonic Nurse Case Manager I to perform care management within licensure for members with complex and chronic care needs, assessing, developing, implementing, coordinating, monitoring, and evaluating care plans designed to optimize health care across the care continuum, with duties conducted telephonically.

This role offers virtual full-time work with required in-person training, a Monday–Friday schedule with occasional evenings, and multi-state licensure is