Nurse Case Manager II

Elevance Health

Full-time - Mid Level

11-50 employees

Insurance Carriers and Related Activities

About the position

The Nurse Case Manager II is responsible for managing care for members with complex and chronic care needs. This role involves assessing, developing, implementing, coordinating, monitoring, and evaluating care plans to optimize member health care across the care continuum. The position requires both telephonic and on-site duties, including discharge planning at hospitals.

Responsibilities

• Ensures member access to services appropriate to their health needs.
• Conducts assessments to identify individual needs and develops a specific care management plan.
• Implements care plans by facilitating authorizations/referrals as appropriate.
• Coordinates internal and external resources to meet identified needs.
• Monitors and evaluates the effectiveness of the care management plan and modifies as necessary.
• Interfaces with Medical Directors and Physician Advisors on 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.

Requirements

• BA/BS in a health-related field and minimum of 5 years of clinical experience; or equivalent combination of education and experience.
• Current, unrestricted RN license in applicable state(s) required.
• Multi-state licensure is required if providing services in multiple states.

Nice-to-haves

• Certification as a Case Manager is preferred.
• BS in a health or human services related field preferred.

Benefits

• Merit increases
• Paid holidays
• Paid Time Off
• Incentive bonus programs
• Medical benefits
• Dental benefits
• Vision benefits
• Short and long term disability benefits
• 401(k) with matching
• Stock purchase plan
• Life insurance
• Wellness programs
• Financial education resources