Nurse Case Manager II

Overview

Anticipated End Date:

Position Title: Nurse Case Manager II

Job Description: The Elevance Health Companies, Inc.

Location: This role enables associates to work virtually full-time, with the exception of required in-person training sessions, providing maximum flexibility and autonomy. The position will be based in Latham, NY;
Seven Hills, OH;
Norfolk, VA;
Columbus, GA.

Please note that per our 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.

Schedule: This position will work an 8-hour shift from 8:00 am – 8:00 pm (EST) Monday to Friday. Additional hours may be necessary based on company needs.

Job Summary: The Nurse Case Manager II 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 care plans designed to optimize member health care across the care continuum. Duties may include telephonic or on-site work (e.g., hospital discharge planning).

How you will make an impact

Primary duties may include, but are not limited to:

• Ensures member access to services appropriate to their health needs.
• Conducts assessments to identify individual needs and develops a specific care management plan to address objectives and goals 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 the 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.
• Negotiates rates of reimbursement, as applicable.
• Assists in problem solving with providers, claims or service issues.
• Assists with development of utilization/care management policies and procedures.

• Requires BA/BS in a health-related field and minimum of 5 years of clinical experience; or any combination of education and experience providing an equivalent background.
• Current, unrestricted RN license in applicable state(s) required.
• Multi-state licensure required if providing services in multiple states.

• Certification as a Case Manager is preferred.
• Homecare background and Hospice experience is preferred.

For URAC-accredited areas: requires a BA/BS and minimum of 5 years of clinical care experience, or an equivalent background. Current and active RN license required in applicable state(s). Multi-state licensure is required if providing services in multiple states. Certification as a Case Manager and a BS in a health or human services related field is preferred.

For candidates working in person or virtually in the listed location(s), the salary range for this position is $79k to $119k.

Locations: New York

Compensation philosophy: In addition to salary, Elevance Health offers a comprehensive benefits package, incentive programs, equity stock purchase, and 401(k) contribution. The salary offered is based on legitimate, non-discriminatory factors and equal pay opportunities are provided in accordance with law.

Salary disclosure notes: The salary range is Elevance Health’s good-faith estimate ual compensation may vary by location, experience, and other factors. No amount is wages or compensation until earned, vested, and determinable under applicable policies. Benefits and bonuses are discretionary unless required by policy.

Job Level: Non-Management Exempt

Workshift: 1st Shift (United States of America)

Job Family: MED >
Licensed Nurse

Equal Opportunity Employer
:
Elevance Health is an Equal Employment Opportunity employer. Applicants who require accommodation to participate in the job application process may contact elevancehealthj for assistance. Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state, and local laws.

How We Work

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

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 looking for leaders passionate about making an impact on our members and the communities we serve.