Nurse Care Manager I

Shift

Monday – Friday; 2:30pm ET - 11:30pm EST

Location

Virtual; Alternate locations may be considered if candidates reside within a commuting distance from an office

Virtual

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.

Please note that per our policy on hybrid/virtual work, candidates not within a reasonable commuting distance from the posting location(s) will not be considered for employment, unless an accommodation is granted as required by law

Shift

Shift: Monday – Friday; 2:30pm ET - 11:30pm EST

Location

Location: Virtual; Alternate locations may be considered if candidates reside within a commuting distance from an office

How You Will Make An Impact

Ensures medically appropriate, high quality, cost effective care through assessing the medical necessity of inpatient admissions and extensions of stay, outpatient services, out of network services, and appropriateness of treatment setting and level of care.

Partners with physician clinical reviewers and/or medical directors to interpret appropriateness of care, intervention planning, and general clinical guidance.

Collaborates with providers to assess consumer needs for early identification of and proactive planning for discharge.

Conducts clinical assessment to develop goals that address individual needs in order to develop and implement a care plan.

Maintains and evaluates the effectiveness of the care management plan and modifies as necessary.

Minimum Requirements

Requires a HS diploma or equivalent and a minimum of 3 years of acute care clinical experience; or any combination of education and experience, which would provide an equivalent background.

Current, active valid unrestricted RN license in applicable state(s) required.

Multi-state licensure is required if this individual is providing services in multiple states.

Preferred Skills, Capabilities, And Experiences

Home health/discharge planning experience preferred.

AS or BS in nursing preferred.

Certification as a Case Manager is preferred.

Critical care (ICU, Emergency Care, strong Medical Surgical background) preferred.

For URAC accredited areas, the following applies:

Current and active RN license required in applicable state(s) that allows for an independent assessment to be conducted within their scope of practice.

Requires 3 years full-time equivalent of direct clinical care experience to the consumer, 5 years full-time equivalent of direct clinical care experience to the consumer preferred or any combination of education and experience, which would provide an equivalent background,

Multi-state licensure is required if this individual is providing services in multiple states.

Certification as a Case Manager or a BS in a health or human services related field also preferred.

Who We Are

Elevance Health is a health company dedicated to improving lives and communities – and making healthcare simpler. We are a Fortune 25 company with a longstanding history in the healthcare industry, looking for leaders at all levels of the organization who are passionate about making an impact on our members and the communities we serve.

How We Work

At Elevance Health, we are creating a culture that is designed to advance our strategy but will also lead to personal and professional growth for our associates. Our values and behaviors are the root of our culture. They are how we achieve our strategy, power our business outcomes and drive our shared success – for our consumers, our associates, our communities and our business.

What We Offer

• Market-competitive total rewards that include merit increases, paid holidays, Paid Time Off, and incentive bonus programs (unless covered by a collective bargaining agreement)
• Medical, dental, vision, short and long term disability benefits
• 401(k) +match, stock purchase plan, life insurance, wellness programs and financial education resources

Health Policy

The health of our associates and communities is a top priority for Elevance Health. We require all new candidates in certain patient/member-facing roles to become vaccinated against COVID-19 and Influenza. If you are not vaccinated, your offer will be rescinded unless you provide an acceptable explanation.

Equal Employment Opportunity

Elevance Health is an Equal Employment Opportunity employer and 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 federal, state, or local laws.

Screening Under Florida Law

Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state, and local laws, including, but not limited to, the Los Angeles County Fair Chance Ordinance and the California Fair Chance Act.