Senior RN Case Manager – Remote Care Coordination

Elevance Health; Boght Corners (NY); Hybrid; USD 84,000 - 126,000; Full time

Job summary

Elevance Health in New York is seeking a Senior Nurse Case Manager to lead complex care management, coordinating plans and resources for members with chronic conditions. Duties are performed telephonically with in-person training as required by policy.

The role emphasizes assessing needs, developing and implementing care plans, and collaborating with Medical Directors to optimize member health outcomes. Hybrid/virtual work and a strong clinical background are essential.

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 home state required.
• Multi-state licensure is required if this individual is providing services in multiple states.

Responsibilities

• Care management within the scope of licensure for members with complex and chronic care needs by assessing, developing, implementing, coordinating, monitoring, and evaluating care plans designed to optimize member health care across the care continuum.
• Performs duties telephonically.
• 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, 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 department audit activities.

Skills

RN license

Multi-state licensure

Education

BA/BS in health-related field

Job description

Elevance Health in New York is seeking a Senior Nurse Case Manager to lead complex care management, coordinating plans and resources for members with chronic conditions. Duties are performed telephonically with in-person training as required by policy.

The role emphasizes assessing needs, developing and implementing care plans, and collaborating with Medical Directors to optimize member health outcomes. Hybrid/virtual work and a strong clinical background are essential.