Care Manager, Telephonic Nurse 2
HumanaSalary not specified
Full Time
Mid-level (3 to 4 years)
Not SpecifiedCompensation
Mid-level (3 to 4 years)Experience Level
Full TimeJob Type
UnknownVisa
HealthcareIndustries
Requirements
- 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)
- Current and active RN license required in applicable state(s)
- Multi-state licensure required if providing services in multiple states
Responsibilities
- Performs duties telephonically or on-site such as at hospitals for discharge planning
- 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
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 II position?
For candidates working in New York or Colorado, the salary range is $76,944 to $120,912.
Is this Nurse Case Manager II role remote or hybrid?
This role enables associates to work virtually full-time, with the exception of 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 the Nurse Case Manager II role?
Requires BA/BS in a health related field and minimum of 5 years of clinical experience, or equivalent combination. Current, unrestricted RN license in applicable state(s) required, with multi-state licensure if providing services in multiple states.
What benefits does Elevance Health offer for this position?
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.
What preferred qualifications will make me stand out for this Nurse Case Manager II role?
Certification as a Case Manager, a BS in a health or human services related field, and oncology experience are preferred.
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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