Nurse Case Manger II - Elevance Health : Job Details

Ensures member access to services appropriate to their health needs. Conducts assessments to identify individual and family needs, and develops a specific care management plan to address the objectives and goals identified during the 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 ed...Nurse, Medical Director, Benefits, Healthcare, Compensation, Management