Nurse Case Manager ll (9am – 6pm Central Time) JR115052Location : Telephonic role. Must reside within 50 miles / 1 hour commute of a relevant Elevance Health office (PulsePoint.)Required work hours : 10am – 7pm Eastern Time, Monday – FridayThe Nurse Case Manager ll 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 the progress of care plans designed to optimize member health care across the care continuum. Performs duties telephonically for post discharge purposes. Primary duties may include, but are not limited to:
Monitors and follows up on member responses through a digital care management application.
Ensures member access to services appropriate to their health needs through active care coordination.
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.
Assists in problem solving with providers, claims or service issues.
Assists with development of utilization/care management policies and procedures.
Minimum Requirements:
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 state of residence required.
Must be able to obtain Multi-state licensure at company expense.
Preferred Qualifications:
Bilingual – English / Spanish .
Multi-state RN licensure a plus!
Post Discharge planning/transitional care experience strongly preferred.
CHD and/or Type ll Diabetes preferred.
Experience using Member 360, HIP, and ability to navigate multiple applications simultaneously.
Telephonic nursing a plus.
Certification as a Case Manager is preferred.
For candidates working in person or remotely in the below locations, the salary range for this specific position is $75,684 to $124,338Locations : Colorado; Nevada; Washington StateIn 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 .
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. Even within the range, the actual compensation will vary depending on the above factors as well as market/business considerations. No amount is considered to be wages or compensation until such amount is earned, vested, and determinable under the terms and conditions of the applicable policies and plans. The amount and availability of any bonus, commission, benefits, or any other form of compensation and benefits that are allocable to a particular employee remains in the Company's sole discretion unless and until paid and may be modified at the Company’s sole discretion, consistent with the law.