Job Description:
Preferred Location: Florida. This role is currently a virtual position in alignment with our virtual policy. However, this is subject to change based on future business needs. The ideal candidate will live within 50 miles of one of our Elevance Health PulsePoint locations.
Nurse Case Manager I
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 on-site such as at hospitals for discharge planning.
**Ideal candidate MUST reside and licensed in the state of Florida.**
**Fingerprint screening is REQUIRED.**
**Monday-Friday 8 am - 5 pm or 9 am - 6 pm EST.**
**Ideal candidate must have experience working with the pediatric population.**
How will you 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.
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.
- Multi-state licensure is required if this individual is providing services in multiple states.
Preferred Skills, Capabilities and Experiences:
- Strong oral, written, and interpersonal communication skills, problem-solving skills, facilitation skills, and analytical skills preferred.
- Certification as a Case Manager is preferred.
- Bi-lingual Spanish-speaking candidate preferred.
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