Remote Telephonic Nurse Case Manager II

Elevance Health; Miami (FL); Hybrid; USD 70,000 - 95,000; Full time

Job summary

Elevance Health is seeking a Telephonic Nurse Case Manager II to coordinate care for members with complex needs. This role is primarily telephonic and may include required in-person training sessions, offering hybrid flexibility and the option to work remotely within commuting distance of an Elevance Health location.

The position emphasizes assessment, care plan development, and coordination of authorizations, with collaboration among Medical Directors and providers to optimize member outcomes

Qualifications

• Requires BA/BS in a health-related field and minimum of 5 years of clinical experience; or any combination of education and experience providing an equivalent background.
• Current, unrestricted RN license in applicable state(s) required.
• Multistate licensure is required if providing services in multiple states.

Responsibilities

• Ensures member access to services appropriate to their health needs.
• Conducts assessments to identify needs and creates tailored care plans.
• Implements care plans by facilitating authorizations/referrals within benefits structure.
• Coordinates internal and external resources to meet identified needs.
• Monitors and evaluates effectiveness of the care management plan and modifies as necessary.
• Interacts with Medical Directors and Physician Advisors on care management plans.
• Assists in problem solving with providers.
• Assists with development of utilization/care management policies and procedures.

Skills

RN license

Clinical experience

Multistate licensure

Telephonic skills

Education

BA/BS in health-related field

Tools

Microsoft 365

Copilot

Job description

Elevance Health is seeking a Telephonic Nurse Case Manager II to coordinate care for members with complex needs. This role is primarily telephonic and may include required in-person training sessions, offering hybrid flexibility and the option to work remotely within commuting distance of an Elevance Health location.

The position emphasizes assessment, care plan development, and coordination of authorizations, with collaboration among Medical Directors and providers to optimize member outcomes