Nurse Case Manager II

Virtual role with required in-person training sessions and one Saturday rotation per month.

About the Role

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. Performs duties telephonically or on-site, such as at hospitals for discharge planning.

Responsibilities

• Ensures member access to services appropriate to their health needs.
• Conducts assessments to identify individual needs and develops specific care management plans to address objectives and goals.
• 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.
• Assists with the development of utilization/care management policies and procedures.

Requirements

• BA/BS in a health-related field and minimum of 5 years of clinical experience; or any combination of education and experience that provides an equivalent background.
• Current, unrestricted RN license in applicable state(s) required.
• Multi-state licensure is required if providing services in multiple states.

Preferred Qualifications

• Certification as a Case Manager.
• BS in a health or human services-related field.
• Bilingual (Spanish).

Pay

For candidates working in Virginia, the salary range for this position is $75,680 - $94,600. The salary offered is based on legitimate, non-discriminatory factors set by the company, including geographic location, work experience, education, and skill level.

Benefits

• Comprehensive benefits package (medical, dental, vision, short and long-term disability).
• 401(k) with company match and stock purchase plan.
• Incentive and recognition programs.
• Paid holidays, Paid Time Off (PTO), and wellness programs.
• Financial education resources and life insurance.

Schedule

Monday–Friday with one Saturday rotation required per month. Hybrid workforce strategy with associates required to work at an Elevance Health location at least once per week.