Nurse Case Mgr II

About This Role

The Nurse Case Manager II is responsible for care management for members with complex and chronic care needs, focusing on assessing, developing, implementing, coordinating, monitoring, and evaluating care plans to optimize member health care.

• Location: Louisville, KY
• Schedule: Full-time, M-F 9:30 AM-6:30 PM EST

• Ensure member access to services appropriate to their health needs.
• Conduct assessments to identify individual needs and develop care management plans.
• Implement care plans by facilitating authorizations/referrals as appropriate.
• Coordinate internal and external resources to meet identified needs.
• Monitor and evaluate the effectiveness of care management plans and modify as necessary.
• Interface with Medical Directors and Physician Advisors on care management treatment plans.
• Negotiate rates of reimbursement, as applicable.
• Assist in problem-solving with providers, claims, or service issues.
• Assist with the development of utilization/care management policies and procedures.

Education:

• Current, unrestricted RN license in applicable state required.

Experience:

• Minimum 2 years’ experience in an acute care setting.
• Case Management experience preferred.
• Utilization Management experience preferred.

Licenses &

Certifications:

• Multi-state licensure required if providing services in multiple states.
• Certification as a Case Manager preferred.

• Merit increases
• Paid holidays
• Paid Time Off
• Incentive bonus programs
• Medical, dental, and vision benefits
• Short and long-term disability benefits
• 401(k) + match
• Stock purchase plan
• Life insurance
• Wellness programs
• Financial education resources

Elevance Health is a health company dedicated to improving lives and communities – and making healthcare simpler. They are a Fortune 25 company with a longstanding history in the healthcare industry, looking for leaders at all levels who are passionate about making an impact on their members and communities.