Telephonic Nurse Case Manager ll
| Company | Elevance Health |
|---|---|
| Location | Indianapolis, IN, USA, Richmond, VA, USA, Mason, OH, USA, Latham, NY, USA, Norfolk, VA, USA, Columbus, OH, USA, Denver, CO, USA, Atlanta, GA, USA, Cincinnati, OH, USA |
| Salary | $76944 – $120912 |
| Type | Full-Time |
| Degrees | Bachelor’s |
| Experience Level | Senior |
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.
- Current, unrestricted RN license in applicable state(s) required.
- Multi-state licensure is required if this individual is providing services in multiple states.
Responsibilities
- 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.
Preferred Qualifications
- Certification as a Case Manager.
- 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.
- Minimum 2 years ‘telephonic’ Case Management experience with a Managed Care Company.
- Managed Care experience.