Senior Nurse Case Manager — Care Coordination Leader

Elevance Health; Rocky Hill (CT); Hybrid; USD 75,000 - 97,000; Full time

Job summary

Elevance Health is seeking a Nurse Case Manager II to collaborate with healthcare providers and consumers to drive personalized health management and improve health outcomes for members with complex and chronic care needs. This role performs care management within licensure scope.

You will assess needs, plan care, coordinate services, and work with teams to ensure appropriate, cost-effective care across inpatient and outpatient settings. A valid RN license and acute care experience are required.

Qualifications

• Requires a HS diploma or equivalent and a minimum of 3 years of acute care clinical experience, home health/discharge planning experience and a minimum of 1 year in a Nurse Care Mgr I role or equivalent experience.
• Current, valid active unrestricted RN license in applicable state(s) required. Multi-state licensure is required if this individual is providing services in multiple states.
• AS or BS in nursing preferred.
• Certification as a Case Manager is preferred. Participation in the American Association of Managed Care Nurses preferred.

Responsibilities

• Ensures medically appropriate, high quality, cost effective care through assessing the medical necessity of inpatient admissions, outpatient services, out of network services, and appropriateness of treatment setting and level of care.
• Partners with physician clinical reviewers and/or medical directors to interpret appropriateness of care, intervention planning, and general clinical guidance.
• Collaborates with providers to assess consumer needs for early identification of and proactive planning for discharge.
• Conducts clinical assessment to develop goals that address individual needs in order to develop a care plan; implements and coordinates a care plan.
• Monitors and evaluates effectiveness of the care management plan and modifies as necessary.
• Assists with development of utilization/care management policies and procedures.
• Participates in or leads intradepartmental teams, projects, and initiatives.

Skills

RN license

Discharge planning

Care management

Education

HS diploma or equivalent

AS or BS in nursing

Tools

Multistate licensure

Job description

Elevance Health is seeking a Nurse Case Manager II to collaborate with healthcare providers and consumers to drive personalized health management and improve health outcomes for members with complex and chronic care needs. This role performs care management within licensure scope.

You will assess needs, plan care, coordinate services, and work with teams to ensure appropriate, cost-effective care across inpatient and outpatient settings. A valid RN license and acute care experience are required.