Nurse Case Manager I

About the role

Carelon, a healthcare services organization, seeks a Nurse Case Manager I to manage the care of members with complex and chronic care needs. The role requires a BA/BS in a health-related field and at least 3 years of clinical experience, with a current, unrestricted RN license in Virginia.

Responsibilities

• Ensure member access to appropriate services based on health needs.
• Conduct assessments to identify individual needs and develop care plans.
• Implement care plans by facilitating authorizations and referrals.
• Coordinate internal and external resources to meet identified needs.
• Monitor and evaluate the effectiveness of care management plans and modify as necessary.
• Interface with Medical Directors and Physician Advisors on care management treatment plans.
• Negotiate rates of reimbursement, as applicable.
• Aid in problem-solving with providers, claims, or service issues.

Requirements

• Bachelor's degree in a health-related field or equivalent experience.
• Minimum of 3 years of clinical experience.
• Current, unrestricted RN license in Virginia.
• Multi-state licensure required if working in multiple states.

Preferred Skills, Capabilities & Experiences

• Certification as a Case Manager.
• MCO case management experience.
• Experience in areas such as hospice, home health, critical care, pediatrics, or adult hospital care.

Benefits

• Comprehensive benefits package.
• Incentive and recognition programs.
• Equity stock purchase program.
• 401(k) match.
• Healthcare coverage (medical, dental, vision).
• Short and long-term disability benefits.
• Life insurance.
• Wellness programs and financial education resources.

Pay

The salary range for this position is $63,840 to $96,600, with additional benefits including a 401(k) match and stock purchase plan. The actual salary may vary based on location and qualifications.

Schedule

Monday - Friday, 8 AM - 5 PM EST.