Remote Telephonic Nurse Case Manager II

Elevance Health, Inc.; Leawood (KS); Remote; USD 75,000 - 115,000; Full time

Job summary

Elevance Health, Inc. is seeking a Telephonic Nurse Case Manager II to perform care management for members with complex needs.

The role is primarily telephonic, with required in-person training sessions and potential alternate locations within commuting distance of an office. The position emphasizes assessing, coordinating, monitoring, and evaluating care plans across the care continuum, with collaboration from Medical Directors and Physician Advisors.

Qualifications

• BA/BS in health-related field and minimum of 5 years clinical experience.
• Current, unrestricted RN license in applicable state(s).
• Multi-state licensure is required if providing services in multiple states.

Responsibilities

• Ensure member access to services appropriate to health needs.
• Conduct assessments to identify needs and develop care management plans.
• Coordinate authorizations/referrals within benefits structure or external arrangements.
• Coordinate internal and external resources to meet identified needs.
• Monitor and evaluate care management plan effectiveness and modify as needed.
• Interface with Medical Directors and Physician Advisors on care plans.
• Negotiate rates of reimbursement where applicable.
• Assist with problem solving with providers, claims or service issues.
• Assist with development of utilization/care management policies and procedures.

Skills

Communication

Critical thinking

Microsoft Office

Education

BA/BS in health-related field

RN license (current, unrestricted)

Multi-state licensure

Tools

Microsoft Office

Job description

Elevance Health, Inc. is seeking a Telephonic Nurse Case Manager II to perform care management for members with complex needs.

The role is primarily telephonic, with required in-person training sessions and potential alternate locations within commuting distance of an office. The position emphasizes assessing, coordinating, monitoring, and evaluating care plans across the care continuum, with collaboration from Medical Directors and Physician Advisors.