Location: 609 H ST NE, STE 200, Washington, DC 20002
Associates are required to live within reasonable proximity (a 50-mile radius and a 1-hour commute) to the Washington, DC office listed above. Elevance Health supports a hybrid workplace model with PulsePoint sites used for collaboration, community, and connection.
Candidates who live in the Washington, DC Metropolitan area are strongly preferred.
This position will take part in Elevance Health's hybrid workforce strategy which includes virtual work and 1-2 days physically in office per week.
Schedule: 8:30 AM - 5:00 PM. Monday through Friday.
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 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:
Maternal child case management and/or behavioral health case management experience is strongly preferred.
1-2 years of managed care and/or case management experience needed to perform job efficiently.
Knowledge and experience working with Medicaid populations.
This position is very phone heavy, roughly 50% of this position will be spent on the phone, experience and comfortability working on the phone; taking inbound and outbound calls is needed.
Experience with InterQual (IQ), Milliman Care Guidelines (MCG) or other criteria used to determine medical necessity strongly preferred.
Utilization management experience is preferred but not required.
Certification as a Case Manager is preferred.
Robust written and oral communication skills.
Exceptional time management and project management skills to efficiently balance and guide various individual tasks and projects.
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.
For candidates working in person or remotely in the below location(s), the salary* range for this specific position is $63,920.00 to $110,262.00 annually.
Location: District of Columbia (Washington, DC).
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.
