Telephonic Nurse Case Manager II

Overview

Location
:
This role enables associates to work virtually full-time, with the exception of required in-person training sessions, providing maximum flexibility and autonomy. This approach promotes productivity, supports work-life integration, and ensures essential face-to-face onboarding and skill development.

Hours
:
Monday - Friday 9:00am to 5:30pm EST and one late evening 11:30am to 8:00pm EST.

Licensure
:
This position will service members in different states; therefore, Multi-State Licensure will be required.

Pre-employment assessment
:
This position requires an online pre-employment skills assessment. The assessment is free of charge and can be taken from any PC with Internet access. Candidates who meet the minimum requirements will be contacted via email with instructions. To move forward, complete the assessment within 48 hours of receipt and meet the criteria.

The Telephonic Nurse Case Manager II is responsible for care management within the scope of licensure for members with complex and chronic care needs by assessing, developing, implementing, coordinating, monitoring, and evaluating care plans designed to optimize member health care across the care continuum. Performs duties telephonically.

• Ensures member access to services appropriate to their health needs.
• Conducts assessments to identify individual needs and develops a specific care management plan to address objectives and goals 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.

• Requires BA/BS in a health-related field and minimum of 5 years of clinical experience; or any combination of education and experience providing an equivalent background.
• Current, unrestricted RN license in applicable state required.
• Multi-state licensure is required if this individual is providing services in multiple states.

• Case Management experience.
• Certification as a Case Manager.
• Minimum 2 years' experience in acute care setting.
• Managed Care experience.
• Ability to talk and type at the same time.
• Demonstrate critical thinking skills when interacting with members.
• Experience with (Microsoft Office) and/or ability to learn new computer programs/systems/software quickly.
• Ability to manage, review and respond to emails/instant messages in a timely fashion.

For candidates working in person or virtually in the below locations, the salary range for this specific position is $79,464 to $130,548.

Locations
:
Colorado;
New York;
New Jersey

In addition to your salary, Elevance Health offers benefits such as a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). The salary offered for this specific position is based on a number of legitimate, non-discriminatory factors set by the Company. The Company is fully committed to ensuring equal pay opportunities for equal work regardless of gender, race, or any other category protected by federal, state, and local pay equity laws.

Notes
:
The salary range is the range Elevance Health in good faith believes is the range of possible compensation for this role at the time of this posting. This range may be modified in the future and actual compensation may vary from posting based on geographic location, work experience, education and/or skill level. No amount is considered wages or compensation until earned, vested, and determinable under applicable policies and plans.

Any bonus, commission, benefits, or other compensation remain in the Company s sole discretion unless and until paid and may be modified at the Company s sole discretion, consistent with the law.

Please note Elevance Health only accepts resumes for compensation from agencies with a signed agreement. Unsolicited resumes submitted to hiring managers are the property of Elevance Health.

Elevance Health is a health company dedicated to improving lives and communities and making healthcare simpler. We are a Fortune 25 company with a longstanding history in the healthcare industry, seeking leaders at all levels who are passionate about making an impact on our members and the communities we serve.

Elevance Health operates in a Hybrid Workforce Strategy. Associates are, unless specified as primarily virtual,…