Telephonic Nurse Case Manager II (Remote)
Elevance Health is seeking a dedicated Telephonic Nurse Case Manager II to join our team. In this role, you will assess, develop, implement, coordinate, monitor, and evaluate care plans designed to optimize member health care across the continuum. This position is conducted primarily via telephone, offering flexibility and the opportunity to work remotely.
Responsibilities:
- Ensure members have access to services appropriate to their health needs.
- Conduct assessments to identify individual needs and develop specific care management plans to address objectives and goals identified during assessments.
- Implement care plans by facilitating authorizations and referrals as appropriate within the benefits structure or through extra-contractual arrangements.
- 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 to develop care management treatment plans.
- Negotiate rates of reimbursement, as applicable.
- Assist in problem-solving with providers, claims, or service issues.
- Contribute to the development of utilization and care management policies and procedures.
Requirements:
- Bachelor's degree in a health-related field.
- Minimum of 5 years of clinical experience, or an equivalent combination of education and experience.
- Current, unrestricted RN license in applicable state(s).
- Multi-state licensure required if providing services in multiple states.
Preferred Qualifications:
- Certification as a Case Manager.
- Managed care experience.
- Ability to talk and type simultaneously.
- Demonstrated critical thinking skills when interacting with members.
- Proficiency with Microsoft Office and the ability to learn new computer programs quickly.
- Experience in oncology and transplant care.
- Knowledge of health insurance benefits, medical management processes, care management, and utilization review management.
Benefits:
- Comprehensive benefits package, including health insurance.
- Incentive and recognition programs.
- Equity stock purchase options.
- 401(k) contributions.
Why Join Us?
At Elevance Health, we are fueled by our bold purpose to improve the health of humanity. We are transforming from a traditional health benefits organization into a lifetime trusted health partner. Our nearly 100,000 associates serve more than 118 million people at every stage of health. We address a full range of needs with an integrated whole health approach, powered by industry-leading capabilities and a digital platform for health. We believe that improving health for everyone is possible. It begins by redefining health, reimagining the health system, and strengthening our communities.
How to Apply:
If you meet the qualifications and are passionate about making a difference in healthcare, we encourage you to apply. Please submit your application through our careers portal. Qualified candidates will be contacted via email with instructions on completing an online pre-employment skills assessment, which must be completed within 48 hours of receipt.