Nurse Case Manager I

Overview Nurse Case Manager I in a field-based role. This position involves traveling to client sites or designated locations as required, with occasional office attendance for meetings or training. Location: Texas (specified counties). Work Hours: Monday – Friday, 8:00 AM – 5:00 PM CST. This role supports care management within the scope of licensure for members with complex and chronic care needs, assessing, developing, implementing, coordinating, monitoring, and evaluating care plans to optimize member health care across the care continuum. Duties may be performed telephonically or on-site (e.g., hospitals for discharge planning). Responsibilities Ensure member access to services appropriate to health needs. Conduct assessments to identify individual needs and develop care management plans with defined objectives and goals. Implement care plans by facilitating authorizations/referrals within benefits or through extra-contractual arrangements. Coordinate internal and external resources to meet identified needs. Monitor and evaluate the effectiveness of the care management plan and modify as necessary. Interface with Medical Directors and Physician Advisors on care management treatment plans. Negotiate rates of reimbursement, as applicable; assist in problem solving with providers, claims, or service issues. Minimum Requirements BA/BS in a health-related field and a minimum of 3 years of clinical experience; or an equivalent combination of education and experience. Current, unrestricted RN license in applicable state(s); multi-state licensure if providing services in multiple states. Certification as a Case Manager is preferred. URAC credential considerations: BA/BS and 3 years of clinical care experience; active RN license; multi-state licensure as applicable. Preferred Skills and Experiences Certification as a Case Manager and a BS in a health or human services field preferred. Experience with home health is highly preferred. Additional Information Equal Employment Opportunity: Elevance Health is an EEO employer. All qualified applicants will receive consideration for employment without regard to age, citizenship status, color, creed, disability, ethnicity, genetic information, gender identity or expression, marital status, national origin, race, religion, sex, sexual orientation, veteran status, or any other status protected by applicable laws. #J-18808-Ljbffr