Description
**Telephonic Nurse Case Manager II**
**Location: This is a virtual position. Prefer candidates reside within 50 miles of an Elevance Health PulsePoint location listed on the requisition.**
**Hours: Monday - Friday 8:00am to 4:30pmEST. May be able to start at a later time if desired but cannot start earlier than 8am EST.**
The **Telephonic Nurse Case Manager II** is responsible for the Case Management and Utilization Management of the complex transplant membership. Assess, develop, implement, coordinate, monitor, and evaluate care plans designed to optimize member health care across the care continuum. Performs duties telephonically.
**How you will 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.
**Minimum Requirements:**
Requires a 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.
Multi-state licensure is required if this individual is providing services in multiple states.
**Preferred Capabilities, Skills and Experiences:**
Certification as a Case Manager is preferred.
Managed Care experience preferred.
Ability to talk and type at the same time.
Demonstrate critical thinking skills when interacting with members.
Experience with (Microsoft Office) and/or ability to learn new computer programs/systems/software quickly.
Ability to manage, review and respond to emails/instant messages in a timely fashion.
Knowledge in Oncology and Transplant preferred.
Knowledge of health insurance/benefits, medical management process, care management, and utilization review management strongly preferred.
For candidates working in person or remotely in the below location(s), the salary* range for this specific position is $75,684 to $113,526.
Locations: New York
In addition to your salary, Elevance Health offers benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). The salary offered for this specific position is based on a number of legitimate, non-discriminatory factors set by the Company. The Company is fully committed to ensuring equal pay opportunities for equal work regardless of gender, race, or any other category protected by federal, state, and local pay equity laws -.-
* The salary range is the range Elevance Health in good faith believes is the range of possible compensation for this role at the time of this posting. This range may be modified in the future and actual compensation may vary from posting based on geographic location, work experience, education and/or skill level. Even within the range, the actual compensation will vary depending on the above factors as well as market/business considerations. No amount is considered to be wages or compensation until such amount is earned, vested, and determinable under the terms and conditions of the applicable policies and plans. The amount and availability of any bonus, commission, benefits, or any other form of compensation and benefits that are allocable to a particular employee remains in the Company's sole discretion unless and until paid and may be modified at the Company's sole discretion, consistent with the law.
Compensation Information:
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