Clinical Care Navigator
Spring HealthSalary not specified
Full Time
Junior (1 to 2 years)
Not SpecifiedCompensation
Junior (1 to 2 years)Experience Level
Full TimeJob Type
UnknownVisa
HealthcareIndustries
Requirements
- 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)
- Multi-state licensure required if providing services in multiple states
Responsibilities
- Assess, develop, implement, coordinate, monitor, and evaluate care plans designed to optimize member health care across the care continuum for members with complex and chronic care needs
- Perform duties telephonically or on-site such as at hospitals for discharge planning
- Ensure member access to services appropriate to their health needs
- Conduct assessments to identify individual needs and develop a specific care management plan to address objectives and goals
- Implement care plan by 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 Physician Advisors on the development of care management treatment plans
- Negotiate rates of reimbursement, as applicable
- Assist in problem solving with providers, claims or service issues
- Assist with development of utilization/care management policies and procedures
Skills
Key technologies and capabilities for this role
Questions & Answers
Common questions about this position
What is the salary range for this Nurse Case Manager I position?
For candidates working in New York or Maryland, the salary range is $68,880 - $103,320. The salary offered is based on legitimate, non-discriminatory factors.
Is this Nurse Case Manager role fully remote?
This role enables associates to work virtually full-time, except for required in-person training sessions. Candidates must be within a reasonable commuting distance from the posting location(s), unless an accommodation is granted.
What are the minimum requirements for this Nurse Case Manager position?
Requires BA/BS in a health related field and minimum of 3 years of clinical experience, or equivalent combination of education and experience. Current, unrestricted RN license in applicable state(s) is required, with multi-state licensure if providing services in multiple states.
What benefits does Elevance Health offer for this role?
In addition to salary, Elevance Health offers a comprehensive benefits package, incentive and recognition programs, equity stock purchase, and 401k contribution, all subject to eligibility requirements.
What preferred qualifications will strengthen my application for this Nurse Case Manager role?
Certification as a Case Manager is preferred, along with a BS in a health or human services related field.
Elevance Health
Integrated health services and digital platform
About Elevance Health
Elevance Health focuses on enhancing the health of individuals throughout their lives by evolving from a traditional health benefits organization into a comprehensive health partner. The company serves over 118 million people, providing support at every stage of health through an integrated approach that addresses a wide range of health needs. Their services are backed by advanced capabilities and a digital health platform that streamlines access to care. Unlike many competitors, Elevance Health emphasizes a holistic view of health, aiming to redefine health and improve community well-being. The ultimate goal is to make health improvements accessible to everyone.
Indianapolis, IndianaHeadquarters
1944Year Founded
$309.4MTotal Funding
IPOCompany Stage
Enterprise Software, Social Impact, HealthcareIndustries
10,001+Employees
Benefits
Medical, dental, & vision insurance
401(k) + match
Paid holidays
Paid Time Off
Incentive bonus programs
Stock purchase plan
Life insurance
Wellness Programs
Financial education resources
Adoption & Surrogacy Assistance
Dependent-care Flexible Spending Account (DCFSA)
Parental Leave
Parental Transition Week
Critical Caregiving Leave
Risks
Departure of CFO John Gallina may create a gap in financial leadership.
Lawsuit against CMS over MA Star Ratings could lead to financial penalties.
CareBridge integration may face operational challenges, disrupting service delivery.
Differentiation
Elevance Health integrates whole health approach with digital health platform for comprehensive care.
Acquisition of CareBridge enhances home health services within Carelon division.
Strategic partnership with Clayton, Dubilier & Rice aims to innovate primary care delivery.
Upsides
AI integration in home health services can reduce hospital readmissions and improve outcomes.
Predictive analytics support early disease detection, aligning with Elevance's whole health approach.
Telehealth expansion offers opportunities to reach more patients remotely.
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