Nurse Case Manager II

Location: This role enables associates to work virtually full-time, except for 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. Must Reside in KY. Please note that per our policy on hybrid/virtual work, 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. This position is not eligible for employment-based sponsorship. Hours: Monday-Friday: 11:30am - 8pm The Nurse Case Mgr 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. Perform duties telephonically. How You Will Make An Impact Ensures member access to services appropriate to their health need Conducts assessments to identify individual needs and a specific care management plan to address objectives and goals as identified during assessment. Implement 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. 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 KY required. Multi-state licensure is required if this individual is providing services in multiple states. Preferred Skills, Capabilities And Experience Certification as a Case Manager is preferred. #J-18808-Ljbffr Elevance Health