Posted on August 9, 2024
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Dates:
From 2024-08-09
Job Description
**Nurse Case Manager I**
**Location: This position is primarily virtual; candidates are required to be residents of the state of Missouri to be considered.** This position will take part in Elevance Health's hybrid workforce strategy which includes virtual-based work and onsite requirements located at **1831 Chestnut St, St. Louis, MO 63103** **,** or in the community as needed by the department only.
Although this position is virtual-based, our ideal candidate will still live within a reasonable proximity (1-hour commute and a 50-mile radius) to the Elevance Health office located at 1831 Chestnut St, St. Louis, MO 63103 **.** Elevance Health supports a hybrid workplace model with PulsePoint sites used for collaboration, community, and connection.
**Schedule: Monday-Friday, 8:00 AM-5:00 PM CST.**
The **Nurse Case Manager I** is 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.
**How You Will Make an Impact**
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 the assessment.
+ Implements care plan by facilitating authorizations/referrals as appropriate within the benefits structure or through extra-contractual arrangements.
+ Coordinates internal and external resources to meet identified needs.
+ Monitors and evaluates the effectiveness of the care management plan and modifies it 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 a 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 Missouri is required.
+ Multi-state licensure is required if this individual is providing services in multiple states.
**Preferred Skills, Capabilities, and Experiences:**
+ Certification as a Case Manager is preferred.
For URAC-accredited areas, the following applies: Requires BA/BS and 3 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. Certification as a Case Manager and a BS in a health or human services-related field preferred.