Work schedule: Monday - Friday 10 am - 7 pm EST.
The Telephonic Nurse Case Manager II is responsible for 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 or on-site such as at hospitals for discharge planning.
How you will make an Impact:
- 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 the assessment. Implements care plan by facilitating authorizations/referrals as appropriate within the benefits structure or through extra-contractual arrangements.
- Coordinates internal and external resources to meet identified needs.
- Monitors and evaluates the effectiveness of the care management plan and modifies it 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 the development of utilization/care management policies and procedures.
Minimum Requirements:
- Requires BA/BS in a health-related field and a 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 applicable state(s) required.
- Multi-state licensure is required if this individual is providing services in multiple states.
Preferred Skills, Capabilities, and Experiences:
- Certification as a Case Manager is preferred.
- BS in a health or human services-related field preferred.
- Strong oral, written, and interpersonal communication skills, problem-solving skills, facilitation skills, and analytical skills.
- Knowledge of the medical management process and the ability to interpret and apply member contracts, member benefits, and managed care products are strongly preferred.
- Prior managed care experience is strongly preferred.
For candidates working in person or remotely in the below locations, the salary range for this specific position is $75,684 to $118,932.
Locations: Colorado; Nevada.
In addition to your salary, Elevance Health offers benefits such as a comprehensive benefits package, incentive and recognition programs, equity stock purchase, and 401k contribution (all benefits are subject to eligibility requirements).
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