Nurse Case Manager ILocation: Must live in Middle Region and live in the State of TN. The ideal candidate will live within 50 miles of one of our Tennessee Elevance Health PulsePoint locations.Hybrid/Virtual.H o urs: General business hours, Monday through FridayThe 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.How you will make an impact:
Performs duties telephonically or on-site such as at hospitals for discharge planning.
Primary duties may include, but are not limited to: 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.
M inimum 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 Experience:
Certification as a Case Manager and a BS in a health or human services related field preferred.
A plus is hospital experience and/or previous Case Management experience preferred.