Telephonic Nurse Case Mgr II

apartment Elevance Health location_onAtlanta, GA, US

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$69,616 - $120,912 / YEAR

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Anticipated End Date:

2025-12-31

Position Title:

Telephonic Nurse Case Mgr II

Job Description:

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. Alternate locations may be considered if candidates reside within a commuting distance from an office.

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 EST and 1 late evening 11:30am to 8:00pm EST.

***This position requires an on-line pre-employment skills assessment. The assessment is free of charge and can be taken from any PC with Internet access. Candidates who meet the minimum requirements will be contacted via email with instructions. In order to move forward in the process, you must complete the assessment within 48 hours of receipt and meet the criteria.

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 assessing, developing, implementing, coordinating, monitoring, and evaluating care plans 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 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.
Assists with development of utilization/care management policies and procedures.

Minimum requirements:

Requires BA/BS in a health related field and minimum of 5 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.
Multi-state licensure is required if this individual is providing services in multiple states.

For URAC accredited areas the following applies: Requires a BA/BS and minimum of 5 years of clinical care experience; or any combination of education and experience, which would provide an equivalent background. Current and active RN license required in applicable state(s). Multi-state licensure is required if this individual is providing services in multiple states.

Preferred Capabilities, Skills, and Experiences:

Certification as a Case Manager preferred.
Ability to talk and type at the same time preferred.
Demonstrate critical thinking skills when interacting with members preferred.
Experience with (Microsoft Office) and/or ability to learn new computer programs/systems/software quickly preferred.
Ability to manage, review and respond to emails/instant messages in a timely fashion preferred.
Minimum 2 years’ experience in acute care setting preferred.
Minimum 2 years’ "telephonic" Case Management experience with a Managed Care Company preferred.
Managed Care experience preferred.

For candidates working in person or virtually in the below location(s), the salary* range for this specific position is $69,616 – $120,912.00

Locations: Minnesota, Maryland, Columbus, OH

In addition to your salary, Elevance Health offers benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). The salary offered for this specific position is based on a number of legitimate, non-discriminatory factors set by the Company. The Company is fully committed to ensuring equal pay opportunities for equal work regardless of gender, race, or any other category protected by federal, state, and local pay equity laws.

* The salary range is the range Elevance Health in good faith believes is the range of possible compensation for this role at the time of this posting. This range may be modified in the future and actual compensation may vary from posting based on geographic location, work experience, education and/or skill level. Even within the range, the actual compensation will vary depending on the above factors as well as market/business considerations. No amount is considered to be wages or compensation until such amount is earned, vested, and determinable under the terms and conditions of the applicable policies and plans. The amount and availability of any bonus, commission, benefits, or any other form of compensation and benefits that are allocable to a particular employee remains in the Company's sole discretion unless and until paid and may be modified at the Company’s sole discretion, consistent with the law.

Job Level:

Non-Management Exempt

Workshift:

1st Shift (United States of America)

Job Family:

MED > Licensed Nurse

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 elevancehealthjobssupport@elevancehealth.com 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.

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Interdisciplinary Teamwork and Collaboration * Effectively communicates to diverse workforce and enjoys mentoring others while learning the necessary skills for progressive responsibilities in nursing management. Works in collaboration with the nurse manager to hold all staff at point of care accountable for performance standards * Creates opportunities for self and staff to grow and implements a healthy, safe, desirable work place that ensure for the retention and recruitment of qualified staff now and in the future. Exemplary Practice and Outcomes * Promote staff competency in clinical care delivery * Holds self and staff to the highest professional and ethical standards, ensuring corporate compliance standards, clinical competency, etc. are met. Is an active member of ones professional community and serves as a role model for professional nursing practice and nursing leadership * Successfully works with nurse managers to employ change management strategies and instills in self and others the curiosity to explore new knowledge and ideas Professional Development * Represents the organization positively to the community, building credibility and as a member of ones professional organization. * Seeks opportunities to advance knowledge and skills through formal and informal educational offerings to enhance understanding of how health care is financed and how to manage a diverse nursing workforce Evidence Based Practice and Research * Promotes Evidence based practice, nursing research and performance improvement in nursing. Participates in activities such as value analysis as part of the decision making process in evaluating patient care products. * Effectively identifies areas of performance improvement of staff and clinical systems. Supports nurse leader projects to improve the same - includes assuring service meets or exceed licensure, regulatory and accreditation standards * Advances managerial skills to effectively use data and evidence to support decision making for clinical and operational responsibilities and demonstrates awareness of legal and ethical issues related to patient and staff data, information and confidentiality Performs other duties as assigned Complies with all WellStar Health System policies, standards of work, and code of conduct. Required Minimum Education: Bachelors Nursing or Masters Nursing Required Minimum License(s) and Certification(s): All certifications are required upon hire unless otherwise stated. RN - Reg Nurse (Single State) or RN-COMPACT - RN - Multi-state Compact BLS - Basic Life Support or BLS-I - Basic Life Support - Instructor Additional License(s) and Certification(s): National certification in nursing administration Upon Hire Preferred Required Minimum Experience: Minimum 3 years of clinical experience Required Required Minimum Skills: Should possess excellent verbal and written communication skills and relationship building; desires to see progressive nursing management roles and enjoys/seeks opportunities to coach and mentor others. Seeks to learn and demonstrate progressive skills in the business of managing a patient care unit or service by obtaining the commitment and productivity of nursing staff. Must be a continuous learner who seeks to better understands health care financing; strategy and operations for running a business unit(s); and effectively employ data and technology to support work processes and make decisions. Supports shared governance or shared decision making; manage the design and delivery of care that in based on evidence and focused on quality and safety. Demonstrates interest and aptitude to achieve knowledge of risk management and various accreditation/regulations/licensing requirements. Join us and discover the support to do more meaningful work—and enjoy a more rewarding life. Connect with the most integrated health system in Georgia, and start a future that gives you more.