Hybrid Nurse Case Manager II

at Elevance Health

• Job title: Nurse Case Manager II
• Job type: Full Time
• Experience level: Mid level, Senior
• Salary: Not specified
• Degree requirement: Bachelor's Degree
• Location requirements: Hybrid, St Louis, United States

About the role

• Telephonic Nurse Case Manager II at Elevance Health providing care management for chronic health needs. Role involves assessing, coordinating, and implementing care plans based on member health requirements.

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 as identified during assessment.
• Implements care plan by facilitating authorizations/referrals as appropriate within benefits structure or through extra-contractual arrangements.
• 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 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 development of utilization/care management policies and procedures.

Requirements

• Requires BA/BS in a health related field and 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.
• Case Management experience is preferred.
• Minimum 2 years’ experience in acute care setting is preferred.
• Managed Care experience is preferred.
• Ability to talk and type at the same time is preferred.
• Demonstrate critical thinking skills when interacting with members is preferred.
• Experience with Microsoft Office and/or ability to learn new computer programs/systems/software quickly is preferred.
• Ability to manage, review and respond to emails/instant messages in a timely fashion is preferred.

Benefits

• Sign on Bonus: $3000
• flexible work arrangements
• medical benefits
• dental benefits
• vision benefits
• paid holidays
• Paid Time Off
• incentive bonus programs
• 401(k) +match
• stock purchase plan
• life insurance
• wellness programs
• financial education resources