The Telephonic Nurse Case Manager II assesses, develops, and monitors care plans for members with complex and chronic health needs. They coordinate internal and external resources while interfacing with medical directors to optimize member healthcare outcomes.
Elevance Health
43 Remote Job Openings at Elevance Health
CareBridge Advance Practice Provider, Nurse Practitioner
Elevance Health
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Full Time
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4 hours ago
Elevance Health
The Nurse Practitioner collaborates with physicians and interdisciplinary teams to develop and implement complex clinical care plans for patients in home and community-based settings. They provide primary and urgent care via telephone and video modalities while maintaining accurate medical documentation and coordinating resources for patients and their families.
CareBridge Advance Practice Provider, Nurse Practitioner
Elevance Health
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Full Time
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4 hours ago
Elevance Health
The Nurse Practitioner collaborates with physicians and interdisciplinary teams to develop and implement complex clinical care plans for patients in home and community-based settings. They provide primary and urgent care via telehealth, manage chronic conditions, and educate patients and families on health maintenance and medication adherence.
CareBridge Advance Practice Provider, Nurse Practitioner
Elevance Health
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Full Time
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4 hours ago
Elevance Health
The Nurse Practitioner collaborates with physicians and interdisciplinary teams to develop and implement complex clinical care plans for patients in home and community-based settings. They provide primary and urgent care via telephone and video modalities while educating patients and families on health management and medication adherence.
CareBridge Advance Practice Provider, Nurse Practitioner - Bilingual
Elevance Health
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Full Time
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4 hours ago
Elevance Health
The Nurse Practitioner collaborates with physicians and interdisciplinary teams to develop and implement complex clinical care plans for patients in home and community-based settings. They provide primary and urgent care via telephone and video modalities while educating patients and families on health management and medication adherence.
CareBridge Advance Practice Provider, Nurse Practitioner - Bilingual
Elevance Health
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Full Time
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4 hours ago
Elevance Health
The Nurse Practitioner collaborates with physicians and interdisciplinary teams to develop and implement complex clinical care plans for patients in home and community-based settings. They provide primary and urgent care via telephone and video modalities while educating patients and families on health management and coordinating care resources.
CareBridge Advance Practice Provider, Nurse Practitioner
Elevance Health
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Full Time
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5 hours ago
Elevance Health
The Nurse Practitioner collaborates with physicians and families to develop and implement complex clinical care plans for patients in home and community-based settings. They provide primary and urgent care via telehealth, identify gaps in care, and educate patients on medication and health management.
The Pharmacy Technician II is responsible for interpreting and entering moderately complex prescriptions, processing prior authorizations, and troubleshooting adjudication issues. They also provide support by resolving grievances, educating members on medication adherence, and coordinating with providers to close care gaps.
Nurse Practitioner 100% Virtual, CareBridge
Elevance Health
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Full Time
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7 hours ago
Elevance Health
The Nurse Practitioner collaborates with physicians and interdisciplinary teams to develop and implement complex care plans for patients with chronic conditions. They provide urgent healthcare via telephone and video modalities while maintaining accurate medical records and educating families on health management.
The Reviewer evaluates medical records to determine the medical necessity of therapy service requests and processes authorization decisions. They also document findings, analyze data, and submit reports in accordance with government regulations and operational goals.
The Outreach Care Specialist I manages clinical referrals and coordinates follow-up care plans to ensure member compliance with treatment. They also identify health risks, support HEDIS/Star program goals, and facilitate referrals to community-based programs.
The LPN/LVN is responsible for examining and treating patients under physician direction, including reviewing medical records and recording vital signs. They provide nursing interventions and coaching while facilitating patient transfers to alternate levels of care.
The Outreach Care Specialist coordinates follow-up care plans and assesses member compliance with medical treatment via telephone or on-site visits. They identify barriers to care, recommend process improvements, and coach members on reducing health risks.
The Nurse Case Manager performs telephonic care management for members with complex and chronic needs by assessing, developing, and monitoring individualized care plans. They coordinate internal and external resources while interfacing with Medical Directors to optimize member health outcomes.
The Coding Analyst Sr. is responsible for auditing and coding medical records to ensure accurate reimbursement, compliance, and documentation. They also provide training and education to staff while serving as a resource for complex coding and billing issues.
The Coding Auditor Sr. is responsible for auditing diagnosis data from medical records to ensure ICD-9 coding accuracy and compliance with risk adjustment requirements. They also serve as a subject matter expert, participate in leadership groups, and identify training opportunities.
The Crisis & Referral Specialist performs safety screenings and telephonic interventions for individuals in crisis to determine appropriate courses of action. They also coordinate with external agencies and organizations to ensure callers access necessary resources and support services.
The Nurse Practitioner collaborates with physicians and interdisciplinary teams to develop and implement complex clinical care plans for patients in home and community-based settings. They provide urgent care via telehealth modalities and educate patients and families on medication, health maintenance, and crisis prevention.
The Inpatient DRG Validator audits medical records to ensure accurate coding and DRG assignment while identifying recoverable claims. They also analyze clinical documentation to substantiate audit findings and suggest process improvements.
Behavioral Health Care Manager II - ABA - GA/NC
Elevance Health
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Full Time
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4 days ago
Elevance Health
The Behavioral Health Care Manager II manages ABA pre-certification health benefits through telephonic or written review using clinical judgment. They also assist with complex cases and serve as a resource to other care managers to ensure quality member outcomes.
The Behavioral Health Case Manager II performs telephonic and in-person case management for members with behavioral health and substance abuse needs. They assess member needs, develop and monitor care plans, and collaborate with internal and external resources to ensure quality, cost-effective care.
The Clinical Review Nurse Senior coordinates and oversees the work of clinical nurse reviewers and non-clinical support teams. They are responsible for responding to complex medical issues and serving as a departmental liaison to other business areas.
Advanced Therapy Services Reviewer (Physical Therapist)
Elevance Health
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Full Time
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6 days ago
Elevance Health
The reviewer conducts clinical case evaluations to determine the medical necessity of therapy services and ensures consistent, compliant decision-making. They also lead peer-to-peer calls with providers and document findings in accordance with regulatory standards.
Advanced Practice Provider, Acute (Nurse Practitioner) - Virtual
Elevance Health
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Full Time
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6 days ago
Elevance Health
The Advanced Practice Provider develops and implements complex care plans for patients via telephone and tele-video modalities. They coordinate with interdisciplinary teams and physicians to ensure optimal care, patient education, and accurate medical documentation.
The Triage Nurse determines appropriate care management programs for members by applying established clinical guidelines and criteria. They facilitate referrals, educate members on healthcare resources, and maintain accurate clinical documentation.
Therapy Services Specialist (Bilingual Spanish)
Elevance Health
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Full Time
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7 days ago
Elevance Health
The Therapy Services Specialist performs telephonic and virtual assessments to identify participant needs and provides recommendations for supportive services. They also educate participants on home modifications and assistive technology while collaborating with the clinical team to document member encounters.
Primary Care Nurse Practitioner, 100% Virtual
Elevance Health
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Full Time
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7 days ago
Elevance Health
The Nurse Practitioner will provide primary and acute care via telehealth to patients in home and community-based settings. They are responsible for developing and implementing complex clinical care plans while coordinating with interdisciplinary teams and family members.
The Behavioral Health Case Manager performs telephonic and field-based case management to assess member needs and develop effective care plans. They monitor the effectiveness of these plans while coordinating with internal and external resources to ensure quality, cost-effective care.
Coordinates and oversees the work of clinical nurse reviewers and non-clinical support teams. Handles complex medical issues and serves as a departmental liaison for process improvement initiatives.
The Billing Specialist Senior is responsible for maintaining the billing system database and reconciling data discrepancies. They provide billing information to internal and external contacts and handle complex billing situations with minimal guidance.
Primary Care Nurse Practitioner, 100% Virtual
Elevance Health
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Full Time
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11 days ago
Elevance Health
Collaborate with physicians and families to develop complex care plans for adult patients with chronic conditions via telephone and video modalities. Provide clinical support, manage medication, and coordinate resources to maximize patient health and independence.
The specialist ensures member treatment plans are followed for moderately complex cases and identifies ways to improve member health. Key duties include coordinating follow-up care, assessing compliance via phone or site visits, and coaching members to reduce health risks.
The specialist ensures member treatment plans are followed for less complex cases and identifies ways to improve member health. Key duties include scheduling follow-up care, assessing compliance via phone or site visits, and coordinating referrals to funded programs.
Nurse Case Manager 1 100% Virtual, Carebridge
Elevance Health
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Full Time
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12 days ago
Elevance Health
Responsible for performing care management for members with complex and chronic needs by assessing, implementing, and monitoring personalized care plans. This includes coordinating internal and external resources and interfacing with Medical Directors to optimize member health outcomes.
Collaborate with providers and Medical Directors to determine the appropriateness of care levels based on Medical Necessity Criteria, primarily for ABA services. Conduct pre-certification, concurrent reviews, and appeals while mentoring Behavioral Health Care Management staff.
Provides clinical guidance and leadership for behavioral health psychology services, focusing on the clinical integrity of ABA and psychological testing programs. Collaborates with providers and Medical Directors to determine appropriate levels of care based on medical necessity criteria.
The role involves assembling and maintaining billing documentation and managing the billing system database. Key tasks include reconciling data discrepancies, posting to sub ledgers, and coordinating account eligibility with internal and external contacts.
Bilingual Nurse Practitioner 100% Virtual, CareBridge
Elevance Health
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Full Time
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18 days ago
Elevance Health
Collaborate with providers and families to develop complex care plans for adult patients with chronic conditions via telephone and video. Provide urgent healthcare support, manage medical documentation, and coordinate resources to maximize patient independence and quality of life.
Pharmacy Technician II – Clinical Pharmacy Care Center
Elevance Health
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Full Time
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19 days ago
Elevance Health
Responsible for interpreting and entering moderately complex prescriptions and processing prior authorizations for Medicare, Medicaid, and Commercial members. The role involves educating members on medication adherence and coordinating with providers to close care gaps.
The role involves verifying member information, educating patients on medication adherence and resources, and coordinating preventive screenings. The technician performs outreach to members and providers to close care gaps and improve health outcomes.
Associate Medical Director - Outpatient Rehab
Elevance Health
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Full Time
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25 days ago
Elevance Health
The Associate Medical Director supports medical management staff by ensuring timely and consistent medical necessity decisions for members and providers. Responsibilities include conducting clinical case reviews, handling grievances and appeals, and performing physician-to-physician calls.
The Behavioral Health Care Manager I conducts utilization management reviews for mental health and substance use disorder benefits. This includes assessing member needs and coordinating care to promote quality outcomes and effective use of health benefits.
The Behavioral Health Care Manager II is responsible for managing psychiatric and substance abuse treatment through telephonic or written review. This role involves assessing member needs, coordinating care, and promoting effective use of health benefits.