Remote Telephonic Nurse Case Manager II

Elevance Health; Indianapolis (IN); Hybrid; USD 85,000 - 110,000; Full time

Job summary

Elevance Health is seeking a Telephonic Nurse Case Manager II to oversee care management for members with complex and chronic conditions, conducting telephonic assessments and coordinating plans across the care continuum.

This role requires a BA/BS in a health-related field, an active RN license, and multi-state licensure if applicable. It operates in a hybrid model with occasional in-person training sessions and standard daytime hours.

Qualifications

• Requires BA/BS in a health-related field and minimum of 5 years of clinical experience.
• Current, unrestricted RN license in applicable state required.
• 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.
• Implements care plan by facilitating authorizations/referrals within benefits or 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 care management 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

Utilization management

Certification as a Case Manager

Acute care experience

Microsoft Office proficiency

Education

BA/BS in a health-related field

RN licensure (state-specific)

Tools

EMR systems

Microsoft Office

Job description

Elevance Health is seeking a Telephonic Nurse Case Manager II to oversee care management for members with complex and chronic conditions, conducting telephonic assessments and coordinating plans across the care continuum.

This role requires a BA/BS in a health-related field, an active RN license, and multi-state licensure if applicable. It operates in a hybrid model with occasional in-person training sessions and standard daytime hours.