RN Case Manager (East Central Indiana) at Elevance Health

Indiana, United States

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Not SpecifiedCompensation

Mid-level (3 to 4 years), Senior (5 to 8 years)Experience Level

Full TimeJob Type

UnknownVisa

Healthcare, Health InsuranceIndustries

Requirements

RN license and minimum of 3 years of experience working with individuals with chronic illnesses, co-morbidities, and/or disabilities in a Service Coordinator, Case Management, or similar role (or equivalent combination of education and experience)
Current, unrestricted RN license in applicable state(s) (Indiana)
Reside in Madison, Delaware, Henry, Wayne, Randolph, Jay, Blackford, Grant, Rush, Fayette, or Union County, Indiana (or within reasonable commuting distance)

Responsibilities

Perform telephonic or face-to-face clinical assessments for identification, evaluation, coordination, and management of member's needs, including physical health, behavioral health, social services, and long-term services and supports
Identify members for high-risk complications and coordinate care with the member and health care team
Manage members with chronic illnesses, co-morbidities, and/or disabilities to ensure cost-effective and efficient utilization of health benefits
Obtain thorough and accurate member history to develop individual care plans, establishing short- and long-term goals in collaboration with member, caregivers, family, natural supports, and physicians
Identify members that would benefit from alternative levels of care or other waiver programs
Develop the care plan for services, ensure member's access to those services, and assist with implementation by facilitating authorizations/referrals within benefits structure or extra-contractual arrangements
Interface with Medical Directors, Physician Advisors, and/or Inter-Disciplinary Teams on development of care management treatment plans
Assist in problem-solving with providers, claims, or service issues
Provide supervision and direction to non-RN clinicians (e.g., LPN/LVN, LSW, LCSW, LMSW) by assigning tasks, verifying and interpreting member information, conducting additional assessments, developing/monitoring/evaluating/revising care plans, and reviewing performance
Overall management of member's case within scope of RN licensure, including developing, monitoring, evaluating, and revising care plans to optimize health care across the care continuum, per IN PathWays for Aging program

Skills

Case Management

Clinical Assessment

Care Planning

Telephonic Assessment

Face-to-Face Assessment

Chronic Disease Management

Behavioral Health Coordination

LTSS

Health Care Coordination

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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