Elevance Health
Overview
Nurse Case Manager I Location: This role enables associates to work virtually full-time, with the exception of required in-person training sessions, providing maximum flexibility and autonomy. This approach promotes productivity, supports work-life integration, and ensures essential face-to-face onboarding and skill development. Candidates not within a reasonable commuting distance from the posting location will not be considered for employment, unless an accommodation is granted as required by law. 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. Duties may be performed telephonically or on-site (e.g., in hospitals for discharge planning). Responsibilities
Ensures member access to services appropriate to their health needs. Conducts assessments to identify individual needs and develops a specific care management plan to address objectives and goals identified during assessment. Implements care plans 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 the 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 that would provide an equivalent background. Current, unrestricted RN license in applicable state(s) required. Multi-state licensure is required if providing services in multiple states. Preferred Skills and Capabilities
Certification as a Case Manager and a BS in a health or human services-related field preferred. Company Information and Policy
Please be advised that Elevance Health only accepts resumes for compensation from agencies that have a signed agreement with Elevance Health. Any unsolicited resumes, including those submitted to hiring managers, are deemed to be the property of Elevance Health. Elevance Health is a health company dedicated to improving lives and communities and is a Fortune 25 company with a longstanding history in the healthcare industry. We are committed to creating a culture that supports personal and professional growth for our associates. Elevance Health operates in a Hybrid Workforce Strategy. Unless specified as primarily virtual by the hiring manager, associates are required to work at an Elevance Health location at least once per week, and potentially several times per week. Specific onsite requirements will be discussed during the hiring process. The health of our associates and communities is a top priority. We require all new candidates in certain patient/member-facing roles to become vaccinated against COVID-19 and Influenza; if not vaccinated, offers may be rescinded unless an acceptable explanation is provided. Elevance Health will follow all relevant federal, state, and local laws. Elevance Health is an Equal Employment Opportunity employer. All qualified applicants will receive consideration for employment without regard to age, citizenship status, color, creed, disability, ethnicity, genetic information, gender (including gender identity and gender expression), marital status, national origin, race, religion, sex, sexual orientation, veteran status, or any other status or condition protected by applicable laws. Applicants who require accommodation to participate in the job application process may contact elevancehealthjobssupport@elevancehealth.com for assistance. Qualified applicants with arrest or conviction records will be considered in accordance with applicable laws, including local fair chance ordinances.
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Nurse Case Manager I Location: This role enables associates to work virtually full-time, with the exception of required in-person training sessions, providing maximum flexibility and autonomy. This approach promotes productivity, supports work-life integration, and ensures essential face-to-face onboarding and skill development. Candidates not within a reasonable commuting distance from the posting location will not be considered for employment, unless an accommodation is granted as required by law. 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. Duties may be performed telephonically or on-site (e.g., in hospitals for discharge planning). Responsibilities
Ensures member access to services appropriate to their health needs. Conducts assessments to identify individual needs and develops a specific care management plan to address objectives and goals identified during assessment. Implements care plans 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 the 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 that would provide an equivalent background. Current, unrestricted RN license in applicable state(s) required. Multi-state licensure is required if providing services in multiple states. Preferred Skills and Capabilities
Certification as a Case Manager and a BS in a health or human services-related field preferred. Company Information and Policy
Please be advised that Elevance Health only accepts resumes for compensation from agencies that have a signed agreement with Elevance Health. Any unsolicited resumes, including those submitted to hiring managers, are deemed to be the property of Elevance Health. Elevance Health is a health company dedicated to improving lives and communities and is a Fortune 25 company with a longstanding history in the healthcare industry. We are committed to creating a culture that supports personal and professional growth for our associates. Elevance Health operates in a Hybrid Workforce Strategy. Unless specified as primarily virtual by the hiring manager, associates are required to work at an Elevance Health location at least once per week, and potentially several times per week. Specific onsite requirements will be discussed during the hiring process. The health of our associates and communities is a top priority. We require all new candidates in certain patient/member-facing roles to become vaccinated against COVID-19 and Influenza; if not vaccinated, offers may be rescinded unless an acceptable explanation is provided. Elevance Health will follow all relevant federal, state, and local laws. Elevance Health is an Equal Employment Opportunity employer. All qualified applicants will receive consideration for employment without regard to age, citizenship status, color, creed, disability, ethnicity, genetic information, gender (including gender identity and gender expression), marital status, national origin, race, religion, sex, sexual orientation, veteran status, or any other status or condition protected by applicable laws. Applicants who require accommodation to participate in the job application process may contact elevancehealthjobssupport@elevancehealth.com for assistance. Qualified applicants with arrest or conviction records will be considered in accordance with applicable laws, including local fair chance ordinances.
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