Remote Telephonic Nurse Case Manager I

Elevance Health; Miami (FL); Remote; USD 67,000 - 116,000; Full time

Job summary

Elevance Health seeks a Telephonic Nurse Case Manager I to perform comprehensive care management for members with complex and chronic needs, assessing, developing, implementing, coordinating, monitoring and evaluating tailored care plans delivered telephonically. Requires a BA/BS in a health-related field and an active RN license with multi-state licensure.

Case management certification and oncology experience are pluses, and the role supports hybrid/virtual work with in-person onboarding as

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

• The Telephonic Nurse Case Manager I is responsible for performing care management within the scope of licensure for members with complex and chronic care needs by assessing, developing, implementing, coordinating, monitoring, and evaluating care plans designed to optimize member health care across the care continuum. Performs duties telephonically.
• 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

RN licensure

Multi-state licensure

Case management

Telephonic care management

Oncology experience

Certification as Case Manager

Education

BA/BS in health-related field

Job description

Elevance Health seeks a Telephonic Nurse Case Manager I to perform comprehensive care management for members with complex and chronic needs, assessing, developing, implementing, coordinating, monitoring and evaluating tailored care plans delivered telephonically. Requires a BA/BS in a health-related field and an active RN license with multi-state licensure.

Case management certification and oncology experience are pluses, and the role supports hybrid/virtual work with in-person onboarding as