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AmeriBen is a proud member of the Elevance Health family of companies. We are a third-party administrator (TPA) of medical benefits, including medical management. The Telephonic 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.
Responsibilities
Ensures members understand benefits and assist in access of 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 through actions based on assessments including providing education, 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 other health professionals on the development of care management treatment plans.
Assists in problem solving for members and providers related to access to care, vendors, claims or service issues, etc.
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 compact RN license in your home state.
Multi-state licensure is required if this individual is providing services in multiple states.
Nice-to-haves
Strong clinical background in hospital setting, i.e. Med Surg, ER, ICU, Critical Care
Ability to talk, type and critically think at the same time.
Demonstrates critical thinking skills when interacting with members.
Experience with (Microsoft Office) and/or ability to learn new computer programs/systems/software quickly.
Ability to manage, review and respond to emails/instant messages in a timely fashion.
Excellent collaboration, communication and teamwork skills.
Benefits
merit increases
paid holidays
Paid Time Off
incentive bonus programs
medical, dental, vision, short and long term disability benefits
