Senior Telephonic Nurse Case Manager for Elevance Health managing complex healthcare needs. Overseeing care management plans with a focus on member health across multiple states.
Responsibilities
Responsible for care management within the scope of licensure for members with complex and chronic care needs
Assess, develop, implement, coordinate, monitor, and evaluate care plans designed to optimize member health care across the care continuum
Conduct assessments to identify individual needs and a specific care management plan
Implement care plan by facilitating authorizations/referrals as appropriate
Coordinate internal and external resources to meet identified needs
Monitor and evaluate effectiveness of the care management plan
Interface with Medical Directors and Physician Advisors on the development of care management treatment plans
Negotiate rates of reimbursement, as applicable
Assist in problem solving with providers, claims or service issues
Participate in department audit activities
Requirements
Requires BA/BS in a health related field
minimum of 5 years of clinical experience
Current, unrestricted RN license in applicable state(s) required
Certification as a Case Manager preferred
Ability to talk and type at the same time preferred
Demonstrate critical thinking skills when interacting with members preferred
Experience with Microsoft Office and/or ability to learn new computer programs/systems/software quickly preferred
Minimum 2 years’ experience in acute care setting preferred
Minimum 2 years’ telephonic Case Management experience with a Managed Care Company preferred
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