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Elevance Health

Sells health insurance and pharmacy benefits

Nurse Case Manager 1

Medical, Clinical & VeterinaryPosted on Nov 10
Full-time

About the Job

Requirements

  • A BA/BS in a health-related field and at least 3 years of clinical experience are required, or an equivalent combination of education and experience.
  • A current, unrestricted RN license in the applicable state(s) is required.
  • Multi-state licensure is required if providing services in multiple states.

Responsibilities

  • Perform 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.
  • Ensure member access to services appropriate to their health needs.
  • Conduct assessments to identify individual needs and develop a specific care management plan to address objectives and goals identified during assessment.
  • Implement care plans by facilitating authorizations and referrals as appropriate 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.
  • Negotiate rates of reimbursement, as applicable.
  • Assist in problem solving with providers, claims, or service issues.
  • Perform duties telephonically or on-site, such as at hospitals for discharge planning.

Desired Qualifications

  • Certification as a Case Manager is preferred.
  • For URAC-accredited areas, a BS in a health or human services-related field 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

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