Nurse Case Manager I
Nurse Case Manager I
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Job Description
Anticipated End Date:
Position Title:
Nurse Case Manager IJob Description:
Nurse Case Manager I
Location: FLTAMPA 5411 SKY CENTER DR
This is a remote position. The ideal candidate will live within 50 miles of one of our Florida PulsePoint locations.
The Nurse Case Manager I will be responsible for performing 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. Performs duties telephonically or onsite such as at hospitals for discharge planning.
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 extracontractual 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.
- Ensure compliance with healthcare regulations and monitor adherence to contractual obligations.
- Ability to handle unexpected changes in assignments and members needs and manage a flexible schedule accommodating field visits and emergency situations.
- Valid drivers license reliable transportation and ability to travel within the service area as needed.
- Conduct facility hospital or home visits to monitor and evaluate care as applicable and/or required.
- Maintaining meticulous records of interactions decisions and care plans for compliance and audit purposes.
- Proficiency in using mobile devices multiples systems and technology to access member records document visits and reports and communicate with the central office.
- Competence in addressing quickly arising issues effectively often requiring creative and immediate solutions.
Minimum Requirements:
- Requires BA/BS in a health related field and minimum of 3 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.
- Multistate licensure is required if this individual is providing services in multiple states.
Preferred Skills Capabilities and Experiences:
- At least two 2 years of experience working withpediatric populations especially in clinical or CM settings preferred.
- Understanding of pediatric conditions treatments and developmental milestones preferred.
- Familiarity with state and federal regulations specific to special needs pediatric care including Medicaid disability determination LTC programs WIC and/or iBudget preferred.
- Strong interpersonal skills for effective communication with members families and healthcare providers during phone calls facetoface visits or MDT meetings as applicable preferred.
- Fluency in both English and a second relevant language (such as Spanish and/or Creole) to effectively communicate with diverse populations strongly preferred.
- Proficient in MS Excel is strongly preferred.
Job Level:
NonManagement ExemptWorkshift:
1st Shift (United States of America)Job Family:
MED > Licensed NursePlease 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 marketcompetitive 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. Candidates must reside within 50 miles or 1hour commute each way of a relevant Elevance Health location.
The health of our associates and communities is a top priority for Elevance Health. We require all new candidates in certain patient/memberfacing roles to become vaccinated against COVID19 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 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.
Required Experience:
Manager
Employment Type
Full-Time
