Nurse Case Manager

Nurse Case Mgr II (US)Telephonic Nurse Case Manager IIThis role enables associates to work virtually full-time, with the exception of required in-person training sessions, providing maximum flexibility and autonomy. This approach promotes productivity, supports work-life integration, and ensures essential face-to-face onboarding and skill development.Monday-Friday, 10 - 6:30 pm EST.Federal Employee Program - FEP, a proud member of the Elevance Health, Inc. family of companies, it is a powerful combination, and the foundation upon which we are creating greater access to care for our members, greater value for our customers, and greater health for our communities. Join us, and together we will drive the future of health care.The Telephonic Nurse Case Manager II 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.How you will make an impact: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 Requirements:Requires BA/BS in a health related field and minimum of 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.Preferred Skills, Capabilities, and Experiences:Certification as a Case Manager is preferred.BS in a health or human services related field preferred.Strong oral, written, and interpersonal communication skills, problem-solving skills, facilitation skills, and analytical skills.Knowledge of the medical management process and the ability to interpret and apply member contracts, member benefits, and managed care products are strongly preferred.Prior managed care experience is strongly preferred.For candidates working in person or virtually in the below locations, the salary* range for this specific position is $80,608 to $120,912.Locations: Colorado.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.Job Level: Non-Management ExemptWorkshift: 1st Shift (United States of America)Job Family: MED > Licensed NurseElevance Health is a health company dedicated to improving lives and communities – and making healthcare simpler. We are a Fortune 25 company with a longstanding history in the healthcare industry, looking for leaders at all levels of the organization who are passionate about making an impact on our members and the communities we serve.At Elevance Health, we are creating a culture that is designed to advance our strategy but will also lead to personal and professional growth for our associates. Our values and behaviors are the root of our culture. They are how we achieve our strategy, power our business outcomes and drive our shared success - for our consumers, our associates, our communities and our business.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.Elevance Health operates in a Hybrid Workforce Strategy. Unless specified as primarily virtual by the hiring manager, associates are required to work at an Elevance Health location at least once per week, and potentially several times per week. Specific requirements and expectations for time onsite will be discussed as part of the hiring process.The health of our associates and communities is a top priority for Elevance Health. We require all new candidates in certain patient/member-facing roles to become vaccinated against COVID-19 and Influenza. If you are not vaccinated, your offer will be rescinded unless you provide an acceptable explanation. Elevance Health will also follow all relevant federal, state and local laws.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 View email address on click.appcast.io for assistance. 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.