Remote Telephonic Nurse Case Manager Lead

Elevance Health; Richmond (VA); Remote; USD 90,000 - 134,000; Full time

Benefits offered by this job

Sign-on bonus $3000

Hybrid/remote work flexibility

Job summary

Elevance Health Telephonic Nurse Case Manager Lead role offers virtual work with occasional in-person training, supporting care management for members with complex needs. It is a lead position coordinating care plans, authorizations, and services across the continuum.

The role requires an RN license and a health-related BA/BS, with case management certification within 3 years. In Virginia, salary ranges from $89,520 to $134,280, with a comprehensive benefits package and hybrid work expectations.

Qualifications

• Requires a BA/BS in a health related field and 5 years of clinical experience.
• Current, unrestricted RN license in applicable state(s) required.
• Case manager certification required within 3 years of starting in this role.

Responsibilities

• 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, chairs and schedules meetings, as well as presents cases for discussion at Grand Rounds/Care Conferences and participates in interdepartmental and/or cross brand workgroups.
• May require the development of a focused skill set including comprehensive knowledge of specific disease process or traumatic injury and functions as preceptor for new care management staff.
• Participates in audit activities and assists supervisor with management of day-to-day activities, such as monitoring and prioritizing workflow, delivering constructive coaching and feedback, and developing associated corrective action plans at direction of the manager.
• Serves as first line contact for conflict resolution.
• Develops training materials, completes quality audits, performs process evaluations, and tests and monitors systems/process enhancements.

Skills

Case management

Managed care experience

RN license

Education

BA/BS in health-related field

Case Manager Certification within 3 years

Job description

Elevance Health Telephonic Nurse Case Manager Lead role offers virtual work with occasional in-person training, supporting care management for members with complex needs. It is a lead position coordinating care plans, authorizations, and services across the continuum.

The role requires an RN license and a health-related BA/BS, with case management certification within 3 years. In Virginia, salary ranges from $89,520 to $134,280, with a comprehensive benefits package and hybrid work expectations.