Elevance Health

The Telephonic Nurse Case Manager II is responsible for 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. Duties include conducting assessments to identify needs, implementing care plans by facilitating authorizations/referrals, coordinating internal and external resources, and interfacing with Medical Directors on treatment plans.

The Telephonic Nurse Case Manager I performs care management for members with complex and chronic care needs by assessing, developing, implementing, coordinating, monitoring, and evaluating care plans telephonically. Responsibilities include ensuring member access to appropriate services, conducting needs assessments, facilitating authorizations/referrals, and coordinating internal and external resources.

The Telephonic Nurse Case Manager II is responsible for 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. Duties are performed telephonically, ensuring member access to appropriate services and conducting assessments to identify needs and create specific care management plans.

The Nutritional Consultant provides nutritional and dietary consultations to participants in patient management programs, ensuring they understand nutritional goals and objectives. This role involves providing counseling and education for patients with chronic conditions and motivating them to enhance their current nutritional plans.

The Advance Practice Provider, Nurse Practitioner is responsible for collaborating with physicians and family members to develop complex plans of care aligned with the patient’s health status and goals, while providing urgent healthcare via telephone and tele-video modalities to patients receiving home and community-based services. This role involves developing and implementing clinical plans of care for adult patients with chronic and complex conditions, gathering necessary diagnostics, and educating patients and families on various aspects of their care.

The Advance Practice Provider is responsible for collaborating with physicians and family members to develop complex plans of care aligned with the patient’s health status and goals. This includes providing urgent health care via telephone and tele-video modalities to patients receiving home and community-based services.

The Social Work Case Manager ensures effective psychosocial intervention to positively impact a patient's ability to manage their chronic illness. This involves utilizing community and government resources to address participant limitations and managing psychosocial needs for improved clinical and financial outcomes.

The Audit and Reimbursement II will support the Medicare Administrative Contract (MAC) by analyzing and interpreting data, preparing detailed work papers, and presenting findings in accordance with Government Auditing Standards and CMS requirements. Responsibilities include performing cost report desk reviews, assisting on cost report audits, and analyzing provider financial documents under guided supervision.

The Audit and Reimbursement II will analyze and interpret data, preparing detailed work papers and presenting findings in accordance with Government Auditing Standards and CMS requirements. Responsibilities include performing cost report desk reviews, assisting on audits, and analyzing provider financial documents under guided supervision.

The Medical Director collaborates with health plan partners, nurse practitioners, and an interdisciplinary team to ensure the delivery of high-quality and cost-effective medical care, potentially developing programs to improve quality, cost, and outcomes. This role involves providing clinical consultation and serving as a clinical/strategic advisor to enhance clinical operations and quality programs.