Telephonic Nurse Case Manager, II

🔥 2 minutes ago

🐊 Florida, New York, +2 more states – Remote

🐊 Florida – Remote 🗽 New York – Remote 🤠 Texas – Remote ⚔️ Virginia – Remote

💵 $75.7k - $119.2k / year

⏰ Full Time

🟡 Mid-level

🟠 Senior

👔 Manager

🦅 H1B Visa Sponsor

This company has sponsored H1B visas in the past.

👻 Ghost score 0%

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Elevance Health

WebsiteLinkedInAll Job Openings

10,000+ employees

🏥 Healthcare

⚕️ Healthcare Insurance

🤝 B2B

Healthcare • Healthcare Insurance • B2B

Elevance Health is transforming from a traditional health benefits organization into a lifetime trusted health partner, driven by a bold purpose to improve the health of humanity. With nearly 100,000 associates, they serve over 118 million people and utilize an integrated whole health approach supported by industry-leading capabilities and a digital health platform. Their mission includes redefining health, reimagining the health system, and strengthening communities.

📋 Description

• Provide telephonic care management for members with complex and chronic care needs within scope of licensure • Assess member needs and develop individualized care management plans • Implement care plans by facilitating authorizations and referrals within benefits structures or through extra-contractual arrangements • Coordinate internal and external resources to meet identified needs • Monitor and evaluate care plan effectiveness and modify plans as necessary • Interface with Medical Directors and Physician Advisors on treatment plans • Ensure member access to appropriate health services • Negotiate reimbursement rates as applicable • Assist with provider, claims, or service issue problem-solving • Assist with development of utilization and care management policies and procedures

🎯 Requirements

• 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 required • Multi-state licensure required when providing services in multiple states • Case Management experience • Certification as a Case Manager • Minimum 2 years’ experience in acute care setting • Managed Care experience • Ability to talk and type at the same time • Critical thinking skills when interacting with members • Experience with Microsoft Office and/or ability to learn new computer programs, systems, and software quickly • Ability to manage, review and respond to emails/instant messages in a timely fashion • Must complete the online pre-employment skills assessment within 48 hours of receipt and meet the criteria • Must reside within a reasonable commuting distance from the posting location(s), unless an accommodation is granted as required by law • Ability to work Monday–Friday 9:00am–5:30pm EST and one late evening 11:30am–8:00pm EST • Multi-State Licensure required to service members in different states

🏖️ Benefits

• Comprehensive benefits package • Incentive and recognition programs • Equity stock purchase • 401k contribution • Merit increases • Paid holidays • Paid Time Off • Incentive bonus programs • Medical benefits • Dental benefits • Vision benefits • Short-term disability benefits • Long-term disability benefits • 401(k) with match • Stock purchase plan • Life insurance • Wellness programs • Financial education resources • Virtual work flexibility • Required in-person training sessions • COVID-19 and Influenza vaccination support/requirement for certain roles