E

Elevance Health

Sells health insurance and pharmacy benefits

Nurse Case Manager 1

Medical, Clinical & VeterinaryConfirmed live in the last 24 hours
Full-time

About the Job

Requirements

  • A BA/BS in a health-related field and at least three years of clinical experience are required, or an equivalent combination of education and experience.
  • A current, unrestricted registered nurse license in the applicable state or states is required.
  • Multistate licensure is required if providing services in multiple states.

Responsibilities

  • Conduct assessments to identify members’ individual health needs and create 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 care-plan effectiveness, modifying plans as necessary, and interface with Medical Directors and Physician Advisors on care-management treatment plans.
  • Assist with problem solving involving providers, claims, or service issues.
  • Perform care management within the scope of licensure for members with complex and chronic care needs, including assessing, developing, implementing, coordinating, monitoring, and evaluating care plans across the care continuum.
  • Perform duties telephonically, including discharge planning at hospitals.

Desired Qualifications

  • Certification as a Case Manager and a BS in a health- or human-services-related field are preferred.
  • A compact registered nurse license is preferred.

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

Recently Posted Jobs

Explore more opportunities at Elevance Health

See more jobs