Nurse Case Mgr Sr
Elevance Health

Job Info

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Nurse Case Mgr Sr - Connecticut

Location: This position is primarily a virtual/remote role. Ideal candidates Must live within 50 miles of the Wallingford, CT Elevance Health Corporate office.

Work Shift: Monday through Friday, 40 hrs. a week.

The Nurse Case Mgr Sr 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. Performs duties telephonically or on-site such as at hospitals for discharge planning.

How will you make an impact:

• 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, chairs and schedules meetings, as well as presents cases for discussion at Grand Rounds/Care Conferences and participates in interdepartmental and/or cross brand workgroups.
  
• May require the development of a focused skill set including comprehensive knowledge of specific disease process or traumatic injury and functions as preceptor for new care management staff.
  
• Participates in department audit activities.
  

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 applicable state(s) required.
  

Preferred Skills, Capabilities and Experiences:

• Certification as a Case Manager is preferred.
  

For URAC accredited areas the following applies: Requires a BA/BS and 5 years of clinical care experience; or any combination of education and experience, which would provide an equivalent background. Current and active RN license required in applicable state(s). Certification as a Case Manager and a BS in a health or human services related field preferred.

This job has expired.