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Elevance Health

Sells health insurance and pharmacy benefits

Telephonic Nurse Case Manager 1

Medical, Clinical & VeterinaryPosted on Nov 9
Full-timeAtlanta, GA, USA

About the Job

Requirements

  • A bachelor's degree in a health-related field, or an equivalent combination of education and experience.
  • Three years of clinical experience, or an equivalent combination of education and experience.
  • A current, unrestricted registered nurse license from the State of Georgia.
  • Multistate licensure is required when providing services in multiple states.
  • Ability to talk and type simultaneously.
  • Ability to use Microsoft Office or quickly learn new computer programs, systems, and software.
  • Ability to manage, review, and respond to emails and instant messages in a timely manner.
  • Must reside in Georgia; candidates must be within reasonable commuting distance of the posting location unless an accommodation is granted.
  • Must complete the online pre-employment skills assessment within 48 hours of receiving instructions and meet the assessment criteria.

Responsibilities

  • Provide telephonic 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.
  • Ensure members have access to services appropriate to their health needs.
  • Conduct assessments to identify individual needs and create specific care management plans with objectives and goals.
  • Implement care plans by facilitating authorizations and referrals within the benefits structure or through extra-contractual arrangements.
  • Coordinate internal and external resources to meet identified needs.
  • Monitor and evaluate the effectiveness of care management plans and modify them as necessary.
  • Interface with Medical Directors and Physician Advisors on the development of care management treatment plans.
  • Assist in resolving provider, claims, or service issues.
  • Assist with developing utilization and care management policies and procedures.
  • Work the stated schedule of Monday through Friday, 11:00 a.m. to 7:30 p.m., with one 8:30 a.m. to 5:00 p.m. Eastern shift per week.
  • Complete required in-person training sessions.

Desired Qualifications

  • Certification as a Case Manager.
  • Demonstrated critical-thinking skills when interacting with members.

About the Company

Elevance Health

Sells health insurance and pharmacy benefits

Elevance Health is one of the largest U.S. health insurers, covering people through employers, individual plans, Medicare and Medicaid. It is the Blue Cross Blue Shield licensee in 14 states, where it sells plans under the Anthem name, and it runs government plans under the Wellpoint name in other markets. Its Carelon division runs the CarelonRx pharmacy benefit manager and sells behavioral health, care management and other services to its own plans and outside clients. Elevance earns most of its revenue from premiums paid by employers, members and government programs, plus fees for Carelon services. The company is headquartered in Indianapolis, Indiana.

Company size
10,001+
Company stage
IPO
Headquarters
Indianapolis, IN
Founded
1944

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