Nurse Case Manager I

About the role

The Nurse Case Manager I will be responsible for performing 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. Duties include conducting assessments, implementing care plans, coordinating resources, and interfacing with Medical Directors and Physician Advisors.

Responsibilities

• Ensures member access to services appropriate to their health needs.
• Conducts assessments to identify individual needs and develop a specific care management plan.
• Implements care plan by facilitating authorizations/referrals as appropriate within benefits structure or through extra-contractual arrangements.
• Captures and coordinates internal and external resources to meet identified needs.
• Makes sure the care management plan is effective and makes necessary modifications.
• Interfaces with Medical Directors and Physician Advisors on the development of care management treatment plans.
• Negotiates rates of reimbursement, as applicable.
• Aids in problem-solving with providers, claims, or service issues.

Requirements

• Requires BA/BS in a health-related field and minimum of 3 years of clinical experience; or any combination of education and experience, which would provide an equivalent background.
• Current and active RN license required in applicable state(s).
• Multi-state licensure is required if this individual is providing services in multiple states.

Preferred Skills, Capabilities & Experiences

• Certification as a Case Manager is preferred.
• Previous MCO or Hospital Case Management experience is preferred.
• Telephonic case management experience preferred.

Benefits

For URAC accredited areas, requires BA/BS and 3 years of clinical care experience; or any combination of education and experience, which would provide an equivalent background. Current and active RN license required in applicable state(s). Certification as a Case Manager and a BS in a health or human services related field preferred.

Pay

$70,560 to $100,800 annually.

Schedule

Monday - Friday, 8AM - 5PM PST.

Who We Are

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, looking for leaders at all levels of the organization who are passionate about making an impact on our members and the communities we serve.

How We Work

We offer a range of market-competitive total rewards that include merit increases, paid holidays, Paid Time Off, and incentive bonus programs (unless covered by a collective bargaining agreement), medical, dental, vision, short and long term disability benefits, 401(k) +match, stock purchase plan, life insurance, wellness programs and financial education resources, to name a few.

Qualifications

• Requires BA/BS in a health-related field and minimum of 3 years of clinical experience; or any combination of education and experience, which would provide an equivalent background.
• Current and active RN license required in applicable state(s).
• Multi-state licensure is required if this individual is providing services in multiple states.
• Certification as a Case Manager is preferred.
• Previous MCO or Hospital Case Management experience is preferred.
• Telephonic case management experience preferred.