Senior Nurse Case Manager II - Remote

IntelliResume; New York (NY); On-site; USD 79,000 - 119,000; Full time

Benefits offered by this job

Comprehensive benefits package

Incentive and recognition programs

Equity stock purchase and 401k

Job summary

Elevance Health is seeking a Nurse Case Manager II to perform care management for members with complex and chronic needs. This role supports flexibility and autonomy in a virtual work environment and is based in Latham, NY.

You will assess, develop, implement, coordinate, monitor, and evaluate care plans, interfacing with Medical Directors and Physician Advisors. Responsibilities include authorizations/referrals, resource coordination, and policy development.

Qualifications

• BA/BS in a health-related field.
• Minimum of 5 years of clinical experience.
• Current, unrestricted RN license in applicable state(s) required.

Responsibilities

• Ensure member access to services appropriate to their health needs.
• Conduct assessments to identify individual needs and develop care management plans.
• Implement care plans by facilitating authorizations/referrals as appropriate.
• Coordinate internal and external resources to meet identified needs.
• Monitor and evaluate the effectiveness of care management plans and modify as necessary.
• Interface with Medical Directors and Physician Advisors on treatment plans.
• Negotiate rates of reimbursement, as applicable.
• Assist in problem-solving with providers, claims, or service issues.
• Assist with the development of utilization/care management policies and procedures.

Education

BA/BS in a health-related field

Job description

Elevance Health is seeking a Nurse Case Manager II to perform care management for members with complex and chronic needs. This role supports flexibility and autonomy in a virtual work environment and is based in Latham, NY.

You will assess, develop, implement, coordinate, monitor, and evaluate care plans, interfacing with Medical Directors and Physician Advisors. Responsibilities include authorizations/referrals, resource coordination, and policy development.