Telephonic Nurse Case Manager

Position Title:

Telephonic Nurse Case Manager I

Location & Work Arrangement:
This role enables associates to work virtually full-time, with the exception of required in-person training sessions. Must reside in the State of Georgia.

Work schedule:

Monday - Friday 11:00am - 7:30pm with one 8:30am to 5pm EST shift per week. Multi‑State Licensure will be required as this position will service members in different states.

• Provide telephonic 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.
• Ensure member access to services appropriate to their health needs.
• Conduct assessments to identify individual needs and develop a specific care management plan to address objectives and goals.
• Facilitate authorizations/referrals as appropriate within benefits structure or through extra‑contractual arrangements.
• Coordinate internal and external resources to meet identified needs.
• Monitor and evaluate effectiveness of the care management plan and modify as necessary.
• Interface with Medical Directors and Physician Advisors on the development of care management treatment plans.
• Assist in problem‑solving with providers, claims or service issues.
• Assist with development of utilization/care management policies and procedures.

• BA/BS in a health‑related field.
• 3 years of clinical experience; or an equivalent combination of education and experience.
• Current, unrestricted RN license from the State of Georgia.
• Multistate licensure required if providing services in multiple states.

• Ability to talk and type simultaneously.
• Certification as a Case Manager.
• Strong critical thinking skills when interacting with members.
• Proficiency with Microsoft Office and ability to learn new programs/software quickly.
• Timely management, review, and response to emails/instant messages.

EEO Statement:
Elevance Health is an Equal Employment Opportunity employer. All qualified applicants will receive consideration for employment without regard to age, citizenship status, color, creed, disability, ethnicity, genetic information, gender (including gender identity and gender expression), marital status, national origin, race, religion, sex, sexual orientation, veteran status, or any other status or condition protected by applicable federal, state, and local laws.