Nurse Case Mgr I (US)

Work Schedule: Monday–Friday, 8:00 AM–4:30 PM, with 2–3 late evenings per month (11:30 AM–8:00 PM).

About the Role

This role enables associates to work virtually full-time, with the exception of required in-person training sessions. Candidates must reside within a reasonable commuting distance from the posting location(s) unless an accommodation is granted as required by law.

The Nurse Case Manager I performs 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 are performed 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 a specific care management plan to address objectives and goals.
• Implements care plan 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 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.

Requirements

• Requires a BA/BS in a health-related field and a minimum of 3 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.

Pay

For candidates working in New York, the salary range for this position is $70,560–$105,840. The salary offered is based on legitimate, non-discriminatory factors such as 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.
• Paid holidays, Paid Time Off (PTO), and incentive bonus programs.
• Life insurance, wellness programs, and financial education resources.

Schedule

Hybrid Workforce Strategy: Associates are required to work at an Elevance Health location at least once per week, with specific requirements discussed during the hiring process.