Remote Telephonic Nurse Case Manager II - Care Coordination

Elevance Health; United States; Hybrid; USD 79,000 - 119,000; Full time

Job summary

Elevance Health in New York is seeking a Telephonic Nurse Case Manager II to coordinate care for members with complex needs, performing assessments, developing and implementing care plans, and coordinating across providers and benefits. This role is primarily telephonic with some in-person training.

Must have an RN license and multi-state licensure, BA/BS in health field and 5 years of clinical experience; multistate licensure required if working across states; salary range listed: $79,464 to

Qualifications

• Requires BA/BS in a health related field and minimum of 5 years of clinical experience; or any combination of education and experience, which would provide an equivalent background.
• Current, unrestricted RN license in applicable state(s) required.
• Multi-state licensure is required if this individual is 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 to address objectives and goals as identified during assessment.
• Implements care plan by facilitating authorizations/referrals as appropriate within benefits structure or through 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 the development of care management treatment 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

Multistate licensure

RN license

Case management

Communication

Critical thinking

Microsoft Office

Email/IM management

Acute care experience

Education

BA/BS in health-related field

Tools

Microsoft Office Suite

Job description

Elevance Health in New York is seeking a Telephonic Nurse Case Manager II to coordinate care for members with complex needs, performing assessments, developing and implementing care plans, and coordinating across providers and benefits. This role is primarily telephonic with some in-person training.

Must have an RN license and multi-state licensure, BA/BS in health field and 5 years of clinical experience; multistate licensure required if working across states; salary range listed: $79,464 to