Address
Form of workat Elevance Health in Boise, Idaho, United States
Job DescriptionWARNING: Please beware of phishing scams that solicit interviews or promote work-at-home opportunities, some of which may pose as legitimate companies. Elevance Health requires a completed online application for consideration of employment for any position. We will never ask you for a credit card, send you a check, or ask you for payment as part of consideration for employment.
"Telephonic" Nurse Case Manager II
+ Job Family: Medical and Clinical
+ Type: Full time
+ Date Posted:Sep 26, 2023
+ Req #: JR85063
Location:
+ GA, ATLANTA
+ National +50 Miles away from nearest PulsePoint
Description
"Telephonic" Nurse Case Manager II
Location: This is a virtual position.
Hours:Monday- Friday 9:00am to 5:30pm with 2 late evenings 11:30am to 8:00pm EST
This position requires an on-line pre-employment skills assessment. The assessment is free of charge and can be taken from any PC with Internet access. Candidates who meet the minimum requirements will be contacted via email with instructions. In order to move forward in the process, you must complete the assessment within 48 hours of receipt and meet the criteria.
The "Telephonic" Nurse Case Manager II 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 or on-site such as at hospitals for discharge planning.
How you will make an impact:
+ Ensures member access to services appropriate to their health needs.
+ Conducts assessments to 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.
+ Negotiates rates of reimbursement, as applicable.
+ Assists in problem solving with providers, claims or service issues.
Minimum Requirements:
+ Requires a BA/BS in a health-related field; 5 years of clinical experience; or any combination of education and experience, which would provide an equivalent background.
+ Minimum 2 years' experience in acute care setting.
+ Current, unrestricted RN license in applicable state(s) required.
+ Multi-state licensure is required if this individual is providing services in multiple states.
+ Minimum 2 years "telephonic" Case Management experience with a Managed Care Company.
+ Managed Care experience required.
Preferred, Skills and Experiences:
+ Certification as a Case Manager is preferred.
+ Ability to talk and type at the same time.
+ Demonstrate critical thinking skills when interacting with members.
+ Experience with (Microsoft Office) and/or ability to learn new computer programs/systems/software quickly.
+ Ability to manage, review and respond to emails/instant messages in a timely fashion.
For candidates working in person or remotely in the below locations, the salary* range for this specific position is $70,320 to $126,576.
Locations: California; Colorado; Nevada; Washington State; Jersey City, NJ; New York City, NY; Ithaca, NY and Westchester County, NY
In 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 compa
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