RN Case Manager I (Colby area)

Elevance Health

Full-time - Mid Level

11-50 employees

Insurance Carriers and Related Activities

About the position

The RN Nurse Case Manager I is responsible for managing care for members with complex and chronic needs, ensuring they receive appropriate services. This role involves assessing individual needs, developing and implementing care plans, coordinating resources, and monitoring the effectiveness of care management strategies. 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 specific care management plans.
• Implements care plans by facilitating authorizations/referrals as appropriate.
• Coordinates internal and external resources to meet identified needs.
• Monitors and evaluates the effectiveness of care management plans 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.

Requirements

• BA/BS in a health-related field.
• Minimum of 3 years of clinical experience or equivalent education and experience.
• Current, unrestricted RN license in applicable state(s).
• Multi-state licensure if providing services in multiple states.

Nice-to-haves

• Certification as a Case Manager.
• Experience working in NICU or OB.

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