Nurse Case Mgr I
Job Family: Medical and Clinical
Type: Full time
Date Posted:Jan 10, 2023
Req #: JR47194
Location:
CO, Denver
National +50 Miles away from nearest PulsePoint, National +50 Miles away from nearest PulsePoint
NV, Las Vegas
Description
$2000 Sign on Bonus
Hours: Monday through Friday 10 a.m. – 6:30 p.m. EST.
Work location: Remote – W@Home
How you will make an Impact:
The Nurse Case Manager I 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.
Primary duties may include, but are not limited to:
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.
Minimum Qualifications:
Requires BA/BS in a health-related field and minimum of 3 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 and a BS in a health or human services related field preferred.
Transplant experience a plus .
Strong oral, written and interpersonal communication skills, problem-solving skills, facilitation skills, and analytical skills.
Knowledge of medical management process and ability to interpret and apply member contracts, member benefits, and managed care products strongly preferred.
Prior managed care experience strongly preferred.
For candidates working in person or remotely in the below locations, the salary* range for this specific position is $60,240 to $108,432
Locations: California, Colorado; Nevada, Jersey City, NJ; New York City, NY; Ithaca, NY, Westchester County, NY and Washington State.
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 .
Please be advised that Elevance Health only accepts resumes from agencies that have a signed agreement with Elevance Health. Accordingly, Elevance Health is not obligated to pay referral fees to any agency that is not a party to an agreement with Elevance Health. Thus, any unsolicited resumes, including those submitted to hiring managers, are deemed to be the property of Elevance Health.
Be part of an Extraordinary Team
Elevance Health is a health company dedicated to improving lives and communities – and making healthcare simpler. Previously known as Anthem, Inc., we have evolved into a company focused on whole health and updated our name to better reflect the direction the company is heading.
We are looking for leaders at all levels of the organization who are passionate about making an impact on our members and the communities we serve. You will thrive in a complex and collaborative environment where you take action and ownership to solve problems and lead change. Do you want to be part of a larger purpose and an evolving, high-performance culture that empowers you to make an impact?
We offer a range of market-competitive total rewards that include merit increases, paid holidays, Paid Time Off, and incentive bonus programs (unless covered by a collective bargaining agreement), medical, dental, vision, short and long term disability benefits, 401(k) +match, stock purchase plan, life insurance, wellness programs and financial education resources, to name a few.
The health of our associates and communities is a top priority for Elevance Health. We require all new candidates to become vaccinated against COVID-19. If you are not vaccinated, your offer will be rescinded unless you provide – and Elevance Health approves – a valid religious or medical explanation as to why you are not able to get vaccinated that Elevance Health is able to reasonably accommodate. Elevance Health will also follow all relevant federal, state and local laws.
Elevance Health has been named as a Fortune Great Place To Work in 2021, is ranked as one of the 2021 World’s Most Admired Companies among health insurers by Fortune magazine, and a Top 20 Fortune 500 Companies on Diversity and Inclusion. To learn more about our company and apply, please visit us at careers.ElevanceHealth.com. Elevance Health is an Equal Employment Opportunity employer and all qualified applicants will receive consideration for employment without regard to age, citizenship status, color, creed, disability, ethnicity, genetic information, gender (including gender identity and gender expression), marital status, national origin, race, religion, sex, sexual orientation, veteran status or any other status or condition protected by applicable federal, state, or local laws. Applicants who require accommodation to participate in the job application process may contact [email protected] for assistance.
EEO is the Law
Equal Opportunity Employer / Disability / Veteran
Please use the links below to review statements of protection from discrimination under Federal law for job applicants and employees.
EEO Policy Statement
EEO is the Law Poster
EEO Poster Supplement-English Version
Pay Transparency
Privacy Notice for California Residents
Elevance Health, Inc. is an E-verify Employer
Need Assistance?
Email us ([email protected]) or call 1-877-204-7664
We Wine. We Dine. We Build Careers! Few restaurants excel at every aspect of the dining experience, from masterfully prepared...
Apply For This JobJOB SUMMARY The Staff Assistant primary responsibility is to provides substantive administrative and management support work, using considerable discretion and...
Apply For This JobJob Description This is an onsite position. Visa Sponsorship is NOT offered now or in the future. Security Support Operations...
Apply For This JobThis is a remote position. Junior React Developer ( US Only)- Full-time remote work Years of experience: 1+ Salary: $60K...
Apply For This JobJob Family Software Development & Support (Digital) Travel Required Up to 10% Clearance Required Ability to Obtain Public Trust Job...
Apply For This JobDescription: Job Summary: This Accessioner I is responsible for the receiving and processing laboratory specimens and requisitions ensuring accuracy of...
Apply For This Job