Remote Telephonic Nurse Case Manager I

Elevance Health; Northern (KY); Hybrid; USD 71,000 - 111,000; Full time

Job summary

Elevance Health is seeking a Telephonic Nurse Case Manager I to manage care for members with complex and chronic needs via telephonic services. The role includes assessments, care planning, and coordination with providers, with required multi-state licensure and occasional in-person training.

Responsibilities include implementing care plans, coordinating resources, monitoring outcomes, and collaborating with Medical Directors to optimize member health across the care continuum.

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 provides services in multiple states.
• Certification as a Case Manager is preferred.

Responsibilities

• Performs telephonic care management within licensure scope.
• Assessments to identify needs and develop a care management plan.
• Implement care plan by facilitating authorizations/referrals within benefits or extra-contractual arrangements.
• Coordinate internal and external resources to meet identified needs.
• Monitor and evaluate effectiveness of the care management plan and modify as needed.
• Interface with Medical Directors and Physician Advisors on care management plans.
• Negotiate rates of reimbursement as applicable.
• Assist in problem solving with providers, claims or service issues.

Skills

Care management

Assessment

Communication

Interpersonal skills

Education

BA/BS in health-related field

Job description

Elevance Health is seeking a Telephonic Nurse Case Manager I to manage care for members with complex and chronic needs via telephonic services. The role includes assessments, care planning, and coordination with providers, with required multi-state licensure and occasional in-person training.

Responsibilities include implementing care plans, coordinating resources, monitoring outcomes, and collaborating with Medical Directors to optimize member health across the care continuum.