Nurse Case Manager Ii

Telephonic Nurse Case Manager II

The Telephonic Nurse Case Manager II position 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:

• Negotiates rates of reimbursement, as applicable.
• Provide support to High-Risk mothers.
• Conducts assessments to identify individual needs and a specific care management plan to address objectives and goals as identified during the assessment.
• Ensures member access to services appropriate to their health needs.
• Coordinates internal and external resources to meet identified needs.
• Monitors and evaluates the effectiveness of the care management plan and modifies, it 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.
• Implements care plan by facilitating authorizations/referrals as appropriate within the benefits structure or through extra-contractual arrangements.
• Assists with the development of utilization/care management policies and procedures.

Minimum Qualifications:

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

Preferred Skills, Capabilities, and Experiences:

• Prior managed care experience is strongly preferred.
• Certification as a Case Manager is preferred.
• Strong oral, written, and interpersonal communication skills, problem-solving skills, facilitation skills, and analytical skills.
• BS in a health or human services-related field is preferred.
• Knowledge of medical management processes and the ability to interpret and apply member contracts, member benefits, and managed care products are strongly preferred.

For candidates working in person or remotely in the below locations, the salary* range for this specific position is $73,836 to $110,754.

Location: Nevada

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.