[Hiring] Nurse Case Manager II (RN) @Elevance Health

Role Description

The Nurse Case Mgr II (RN) is responsible for care management within the scope of licensure for members with complex and chronic care needs. Care management is conducted through:

• Screening
• Assessing
• Stratifying risk
• Planning
• Implementing (care coordination)
• Following up
• Transitioning (transitional care)
• Communicating post transition
• Evaluating members

Our care model is designed to optimize member health care across the care continuum. We provide meaningful interventions that drive improvements in clinical outcomes, productivity, and quality of life. This is an outbound calling program, 100% telephonic.

Qualifications

• Requires BA/BS in a health-related field
• Minimum of 5 years of clinical experience; or any combination of education and experience that provides an equivalent background
• Current, unrestricted RN license in applicable state(s) is required
• Multi-state RN licensure is required for providing services in multiple states upon hire

Requirements

• 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
• Assists in 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 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

Benefits

• Comprehensive benefits package
• Incentive and recognition programs
• Equity stock purchase
• 401k contribution (subject to eligibility requirements)