Elevance Health

The Medical Management Nurse reviews complex cases requiring nursing judgment to determine the medical necessity of requested services by assessing the member's clinical presentation and working with healthcare providers. This role involves applying clinical guidelines, consulting with the Medical Director on unclear cases, and potentially recommending alternate types or levels of appropriate care.

The Nurse Case Manager II for Transplant is responsible for telephonic care management for transplant members with complex needs by assessing, developing, implementing, coordinating, monitoring, and evaluating care plans. This clinician also ensures appropriate plan benefit administration by reviewing clinical information and assessing medical necessity under relevant guidelines and policies.

The Triage Nurse I is responsible for determining the appropriate Care Management program for referred members by utilizing department guidelines and established criteria. Primary duties involve applying the nursing process to meet health needs, educating members on providers, and collaborating with medical management to identify issues and assign appropriate care management components.

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 individual needs and specific care management plans.

The RN is responsible for determining the appropriate Care Management program for referred members by utilizing department guidelines and established criteria to assign them to the correct care management component. Primary duties involve using the nursing process to meet health needs, educating members about providers, and collaborating with medical and care management associates to identify issues and assign 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 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 Pharmacist Consultant supports disease management programs and physician care plans by evaluating drug therapy and consulting for program participants. Responsibilities include reviewing member medication history, assessing compliance through direct contact with members and physicians, and counseling physicians on alternative therapies when standards are not met.

The Respiratory Therapist provides guidance to condition management members to facilitate positive lifestyle changes aimed at improving respiratory health. This involves collaborating with other health professionals and instructing members on the proper use of equipment like inhalers, Bipaps, and peak flow meters, alongside prevention techniques.

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.