**Telephonic Nurse Case Manager II**
**Location:** This role enables associates to work virtually full-time, with the exception of required in-person training sessions, providing maximum flexibility and autonomy. This approach promotes productivity, supports work-life integration, and ensures essential face-to-face onboarding and skill development.
**_Please note that per our policy on hybrid/virtual work, candidates not within a reasonable commuting distance from the posting location(s) will not be considered for employment, unless an accommodation is granted as required by law._**
**Hours: Monday - Friday 9:00am to 5:30pm with 2 evening shifts every week 11:30am to 8:00pm in your time zone.**
***This position will service members in different states; therefore, Multi-State Licensure will be required.**
The **Telephonic Nurse Case Manager II** is responsible for care management within the scope of licensure for members with complex and chronic care needs by screening, assessing, stratifying risk, planning, implementing (care coordination), following up, transitioning (transitional care), communicating post transition, and evaluating. Care planning is 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 other Health Professionals on the development of care management treatment plans.
+ Assists in problem solving with providers, claims or service issues.
+ Assists with development of utilization/care management policies and procedures.
**Minimum Requirements:**
+ Requires BS in a health-related field and minimum of 5 years of nursing clinical experience.
+ Current, unrestricted RN license is required. Multi-state licensure will be required, as individual will be providing services in multiple states.
+ Minimum 2 years Case Management experience; or any combination of education and experience, which would provide an equivalent background.
**Preferred Capabilities, Skills and Experiences:**
+ Experience with Microsoft Office Suite preferred, and/or the ability to learn new computer programs, systems, and software quickly preferred.
+ Ability to talk and type at the same time preferred.
+ Minimum 2 years of experience in an acute care setting preferred.
+ Telephonic and/or virtual nursing experience preferred.
+ Managed Care experience preferred.
+ Certification as a Case Manager preferred.
Please be advised that Elevance Health only accepts resumes for compensation from agencies that have a signed agreement with Elevance Health. Any unsolicited resumes, including those submitted to hiring managers, are deemed to be the property of Elevance Health.
Who We Are
Elevance Health is a health company dedicated to improving lives and communities - and making healthcare simpler. We are a Fortune 25 company with a longstanding history in the healthcare industry, looking for leaders at all levels of the organization who are passionate about making an impact on our members and the communities we serve.
How We Work
At Elevance Health, we are creating a culture that is designed to advance our strategy but will also lead to personal and professional growth for our associates. Our values and behaviors are the root of our culture. They are how we achieve our strategy, power our business outcomes and drive our shared success - for our consumers, our associates, our communities and our business.
We offer a range of market-competitive total rewards that include merit increases, paid holidays, Paid Time Off, and incentive bonus programs (unless covered by a collective bargaining agreement), medical, dental, vision, short and long term disability benefits, 401(k) +match, stock purchase plan, life insurance, wellness programs and financial education resources, to name a few.
Elevance Health operates in a Hybrid Workforce Strategy. Unless specified as primarily virtual by the hiring manager, associates are required to work at an Elevance Health location at least once per week, and potentially several times per week. Specific requirements and expectations for time onsite will be discussed as part of the hiring process.
The health of our associates and communities is a top priority for Elevance Health. We require all new candidates in certain patient/member-facing roles to become vaccinated against COVID-19 and Influenza. If you are not vaccinated, your offer will be rescinded unless you provide an acceptable explanation. Elevance Health will also follow all relevant federal, state and local laws.
Elevance Health is an Equal Employment Opportunity employer and all qualified applicants will receive consideration for employment without regard to age, citizenship status, color, creed, disability, ethnicity, genetic information, gender (including gender identity and gender expression), marital status, national origin, race, religion, sex, sexual orientation, veteran status or any other status or condition protected by applicable federal, state, or local laws. Applicants who require accommodation to participate in the job application process may contact
[email protected] for assistance.
Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state, and local laws, including, but not limited to, the Los Angeles County Fair Chance Ordinance and the California Fair Chance Act.