Telephonic RN Nurse Case Manager I - AmeriBen

Telephonic RN Nurse Case Manager I – AmeriBen Location: This role enables associates to work virtually full-time, with the exception of required in‑person training sessions, providing maximum flexibility and autonomy. Candidates not within a reasonable commuting distance from the posting location(s) will not be considered for employment, unless an accommodation is granted as required by law. Hours: Monday thru Friday 8am to 5pm (local time). Responsibilities Perform 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 healthcare across the care continuum. Perform duties telephonically or on‑site, such as at hospitals for discharge planning. Ensure members understand benefits and assist in access of services appropriate to their health needs. Conduct assessments to identify individual needs and develop a specific care management plan. Implement the plan through actions based on assessments, including providing education, facilitating authorizations/referrals as appropriate within benefits structure or through extra‑contractual arrangements. Coordinate internal and external resources to meet identified needs. Monitor and evaluate effectiveness of the care management plan and modify as necessary. Interface with Medical Directors and other health professionals on the development of care management treatment plans. Assist in problem solving for members and providers related to access to care, vendors, claims or service issues. Minimum Requirements BA/BS in a health related field and minimum of 3years of clinical experience; or any combination of education and experience that provides an equivalent background. Current, unrestricted compact RN license in your home state. Multi‑state licensure is required if this individual is providing services in multiple states. Preferred Capabilities, Skills and Experiences Previous experience with utilization review and/or prior authorization. Clinical case management experience in an inpatient or outpatient setting. Ability to talk, type and critically think at the same time. Demonstrates critical thinking skills when interacting with members. Experience with MicrosoftOffice 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. Excellent collaboration, communication and teamwork skills. Benefits Market‑competitive total rewards including 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) with company match; stock purchase plan; life insurance; wellness programs; financial education resources. Job Details Job Level: Non‑Management Exempt Workshift: 1st Shift (United States of America) Job Family: MED > Licensed Nurse Legal Notice – Equal Employment Opportunity 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, and local laws. Applicants who require accommodation to participate in the job application process should submit the following form: Accessibility Accommodation Request Form and a member of the team will be in contact. Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state, and local laws, including, but not limited to, the Los Angeles County Fair Chance Ordinance and the California Fair Chance Act. Prospective employees required to be screened under Florida law should review the education and awareness resources at HB531 | Florida Agency for Health Care Administration. #J-18808-Ljbffr