Telephonic Nurse Case Manager II

Elevance Health; New York (NY); Remote; USD 76.000 - 119.000; Vollzeit

Benefits dieser Stelle

Comprehensive benefits package

Incentive and recognition programs

Equity stock purchase and 401k

Zusammenfassung

Elevance Health in the United States seeks a Telephonic Nurse Case Manager II to oversee care management for members with complex and chronic care needs, focusing on assessing, developing, implementing, coordinating, monitoring, and evaluating care plans in a flexible, virtual role.

The role requires a BA/BS in a health-related field, a current RN license, and at least 5 years of clinical experience, including acute care; multi-state licensure is preferred.

Qualifikationen

• BA/BS in a health-related field is required.
• RN license in applicable state required; multi-state licensure if providing services in multiple states.
• Certification as a Case Manager is preferred.

Aufgaben

• 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

Ausbildung

BA/BS in a health-related field

Jobbeschreibung

About This Role

The Telephonic Nurse Case Manager II is responsible for care management for members with complex and chronic care needs, focusing on assessing, developing, implementing, coordinating, monitoring, and evaluating care plans. This role is ideal for experienced nurses seeking a flexible, virtual work environment.

Highlights

• Pay: $75,680 - $119,196/year
• Location: Latham, NY
• Schedule: Full-time, Monday–Friday, 8:30 AM to 5:00 PM with 2–4 late shifts per month

What You'll Do

• 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

Requirements

Education:

• BA/BS in a health-related field required

Experience:

• Minimum of 5 years of clinical experience required
• Minimum 2 years’ experience in an acute care setting preferred

Licenses & Certifications:

• Current, unrestricted RN license in applicable state required
• Multi-state licensure required if providing services in multiple states
• Certification as a Case Manager preferred

Benefits

• Comprehensive benefits package
• Incentive and recognition programs
• Equity stock purchase and 401k contribution

About Elevance Health

Elevance Health is a health company dedicated to improving lives and communities – and making healthcare simpler. They are a Fortune 25 company with a longstanding history in the healthcare industry, looking for leaders at all levels who are passionate about making an impact on their members and communities.