Nurse Case Manager II

Company: Elevance Health
Location: Atlanta
Posted on: September 4, 2024

Job Description:

Location: Virtual; Eastern and Central time zone candidates preferred, Within 50 miles of an Elevance Health Pulse Point locationShift: Monday - Friday; 10:00am - 6:30pm ET; 1-2 late nights per month required 11:30am - 8:00pm ETThe 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. 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.
• Assists in problem solving with providers, claims or service issues.
• Assists with development of utilization/care management policies and procedures.Minimum Requirements
  • Requires BA/BS in a health-related field and minimum of 5 years of clinical experience; or any combination of education and experience, which would provide an equivalent background.
  • Current, unrestricted RN license in applicable state(s) required.
  • Multi-state licensure is required if this individual is providing services in multiple states.Preferred Skills, Capabilities, And Experiences
    • Certification as a Case Manager is preferred.
    • Telephonic Case Management experience preferred.For URAC Accredited Areas The Following Applies
      • Requires a BA/BS and minimum of 5 years of clinical care experience; or any combination of education and experience, which would provide an equivalent background.
      • Current and active RN license required in applicable state(s).
      • Multi-state licensure is required if this individual is providing services in multiple states.
      • Certification as a Case Manager and a BS in a health or human services related field preferred.

Keywords: Elevance Health, Atlanta , Nurse Case Manager II, Executive , Atlanta, Georgia