Remote Telephonic Nurse Case Manager II

Elevance Health; Virginia; Hybrid; USD 85,000 - 110,000; Full time

Job summary

Elevance Health is hiring a Telephonic Nurse Case Manager II to coordinate care for members with complex and chronic needs. The role involves assessing needs, developing and implementing care plans, coordinating authorizations and referrals, and monitoring outcomes to improve health across the care continuum.

The position requires an active RN license, a BA/BS in a health-related field, and Case Management certification, with at least two years in acute care.

Qualifications

• BA/BS in health-related field is required.
• Current, unrestricted RN license in applicable state required.
• Case Management experience is required.
• Certification as a Case Manager is required.
• Minimum 2 years’ experience in acute care setting.
• Experience with Microsoft Office and ability to learn new software quickly.
• Ability to manage, review and respond to emails/instant messages promptly.

Responsibilities

• Conduct care management for members with complex and chronic needs by assessing, developing, implementing, coordinating, monitoring, and evaluating care plans to optimize health care across the continuum.
• Identify individual needs and create a care management plan during assessment.
• Facilitate authorizations/referrals within benefits structure or extra-contractual arrangements as needed.
• Monitor and adjust care plans based on effectiveness.
• Collaborate with Medical Directors and Physician Advisors on treatment plans.
• Negotiate reimbursement rates where applicable.
• Assist with problem solving regarding providers, claims, or service issues.
• Assist in development of utilization/care management policies and procedures.

Skills

Case management

Email/communication

Education

BA/BS in health-related field

RN license

Tools

Microsoft Office

Job description

Elevance Health is hiring a Telephonic Nurse Case Manager II to coordinate care for members with complex and chronic needs. The role involves assessing needs, developing and implementing care plans, coordinating authorizations and referrals, and monitoring outcomes to improve health across the care continuum.

The position requires an active RN license, a BA/BS in a health-related field, and Case Management certification, with at least two years in acute care.