Nurse Case Manager I
Company: Elevance Health
Location: Miami
Posted on: January 26, 2023
Job Description:
Nurse Case Manager I
- Job Family: Medical and Clinical
- Type: Full time
- Date Posted:Jan 11, 2023
- Req #: JR44168Location:
- Indiana, Indiana
- Kentucky, Kentucky
- Florida, Florida
- Virginia, Virginia
- Ohio, Ohio
- Maine, Maine
- Georgia, GeorgiaDescription$2000 Sign on BonusHours: Monday
through Friday 10 a.m. - 6:30 p.m. EST.Location: Remote (Within 2
hours of the following Elevance Health offices); Indiana, Georgia,
Florida, Kentucky, Maine, Ohio or Virginia.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.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 TeamElevance 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 Worlds 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 ability@icareerhelp.com for assistance.EEO is the LawEqual
Opportunity Employer / Disability / VeteranPlease 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 ResidentsElevance Health, Inc. is
an E-verify EmployerNeed Assistance?Email us
(elevancehealth@icareerhelp.com) or call 1-877-204-7664
Keywords: Elevance Health, Miami , Nurse Case Manager I, Executive , Miami, Florida
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