Telephonic Nurse Case Manager Senior
Elevance Health

Telephonic Nurse Case Manager Senior

Location: This is a virtual position. Candidates must reside within 50 miles of an Elevance Health Pulse Point location.

Hours: Monday - Friday 9:00am to 5:30pm EST and 1 late evening 11:30am to 8:00pm EST.

***This position will service members in different states; therefore, Multi-State Licensure will be required.

***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 Senior 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.

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.
  
• Assists with development of utilization/care management policies and procedures, chairs and schedules meetings, as well as presents cases for discussion at Grand Rounds/Care Conferences and participates in interdepartmental and/or cross brand workgroups.
  
• May require the development of a focused skill set including comprehensive knowledge of specific disease process or traumatic injury and functions as preceptor for new care management staff.
  
• Participates in department audit activities.
  

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
  
• 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.
  
• Minimum 2 years' experience in acute care setting preferred.
  
• Minimum 2 years "telephonic" Case Management experience with a Managed Care Company preferred.
  
• Managed Care experience preferred.
  

For candidates working in person or remotely in the below location(s), the salary* range for this specific position is $75,684 to $124,338.

Locations: California, Colorado and New York

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 Company. The Company is fully committed to ensuring equal pay opportunities for equal work regardless of gender, race, or any other category protected by federal, state, and local pay equity laws.

* The salary range is the range Elevance Health in good faith believes is the range of possible compensation for this role at the time of this posting. This range may be modified in the future and actual compensation may vary from posting based on geographic location, work experience, education and/or skill level. Even within the range, the actual compensation will vary depending on the above factors as well as market/business considerations. No amount is considered to be wages or compensation until such amount is earned, vested, and determinable under the terms and conditions of the applicable policies and plans. The amount and availability of any bonus, commission, benefits, or any other form of compensation and benefits that are allocable to a particular employee remains in the Company's sole discretion unless and until paid and may be modified at the Company's sole discretion, consistent with the law.

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