Telephonic Nurse Case Manager

Overview

Sign on Bonus: $3000.

Alternate locations may be considered if candidates reside within a commuting distance from an office.

Note:

per policy on hybrid/virtual work, candidates not within a reasonable commuting distance from the posting location(s) will not be considered for employment, unless an accommodation is granted as required by law.

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

Hours: Monday – Friday 8:00 am – 5:00 pm CST.

• The Telephonic Nurse Case Manager I is 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. Performs duties telephonically for discharge planning.
• 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 identified during assessment.
• Implement care plans by facilitating authorizations/referrals as appropriate within benefits structure or through extra-contractual arrangements.
• Coordinate internal and external resources to meet identified needs.
• Monitor and evaluate the 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.
• Negotiate rates of reimbursement, as applicable; assist in problem solving with providers, claims or service issues.

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

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

Be advised that 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.

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

How We Work:
Elevance Health is creating a culture designed to advance our strategy and support personal and professional growth. We offer market-competitive total rewards including merit increases, paid holidays, PTO, incentive programs (unless covered by a collective bargaining agreement), medical/dental/vision, disability benefits, 401(k) with match, stock purchase plan, life insurance, wellness programs, and financial education resources.

Hybrid/Onsite expectations:
Elevance Health operates a Hybrid Workforce Strategy. Unless specified as primarily virtual by the hiring manager, associates are required to work at a location at least once per week and potentially several times per week. Specific onsite requirements will be discussed during the hiring process.

Vaccination:
The health of our associates and communities is a top priority. New candidates in certain patient/member-facing roles may be required to be vaccinated against COVID-19 and Influenza. If not vaccinated, offers may be rescinded unless an acceptable explanation is provided. We follow all relevant laws.

Equal Employment Opportunity:
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 identity and expression), marital status, national origin, race, religion, sex, sexual orientation, veteran status or any other status protected by law. Applicants needing accommodation to participate in the job application process may contact elevancehealthj Qualified applicants with arrest or conviction records will be considered in accordance with federal, state, and local laws, including applicable fair chance acts.