Telephonic Nurse Case Manager II at Elevance Health

Iselin, New Jersey, United States

Elevance Health Logo
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
  • Multi-state licensure required if providing services in multiple states

Responsibilities

  • 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

NursingCase ManagementCare PlanningTelephonic AssessmentMulti-State LicensureChronic Care ManagementCare CoordinationHealth AssessmentReferral ManagementBenefit Authorization

Questions & Answers

Common questions about this position

What is the work arrangement for this role?

This role enables associates to work virtually full-time, with the exception of required in-person training sessions. Candidates not within a reasonable commuting distance from the posting location(s) will not be considered unless an accommodation is granted.

What are the minimum qualifications for this position?

Requires BA/BS in a health-related field and minimum of 5 years of clinical experience, or equivalent combination of education and experience. Current, unrestricted RN license in applicable state is required, and multi-state licensure is required if servicing members in multiple states.

What are the preferred skills and experiences for this role?

Preferred qualifications include case management experience, certification as a case manager, minimum 2 years’ experience in acute care setting, and managed care experience.

What are the working hours for this position?

Hours are Monday - Friday 9:00am to 5:30pm EST and 1 late evening 11:30am to 8:00pm EST.

What is the application process like for this role?

This position requires an online pre-employment skills assessment, which is free and can be taken from any PC with internet access. Candidates who meet minimum requirements will receive email instructions and must complete it within 48 hours.

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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