Telephonic Nurse Case Manager II working virtually for Elevance Health. Focused on care management for members with complex chronic care needs through assessments, coordination, and monitoring.
Responsibilities
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
Assists in facilitating authorizations/referrals as appropriate within benefits structure
Coordinates internal and external resources to meet identified needs
Monitors and evaluates effectiveness of the care management plan and modifies as necessary
Interfaces with Medical Directors and other Health Professionals on the development of care management treatment plans
Assists in problem solving with providers, claims or service issues
Assists with development of utilization/care management policies and procedures
Requirements
Requires BS in a health-related field and minimum of 5 years of nursing clinical experience
Current, unrestricted RN license is required
Multi-state licensure will be required
Experience with Microsoft Office suite preferred
Ability to talk and type at the same time preferred
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