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About the Role

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. 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 a specific care management plan to address objectives and goals as identified during assessment.
• 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 BA/BS in a health related field and minimum of 3 years of clinical experience; or any combination of education and experience, which would provide an equivalent background.
• Current, unrestricted RN license in applicable state(s) required.
• Multi-state licensure is required if this individual is providing services in multiple states.
• For URAC accredited areas the following applies: Requires BA/BS and 3 years of clinical care experience; or any combination of education and experience, which would provide an equivalent background.
• Current and active RN license required in applicable state(s).
• Multi-state licensure is required if this individual is providing services in multiple states.

Skills

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

Location

• Latham- New York
• Seven Hills - Ohio
• Norfolk- Virginia
• Colombus- Georgia

Work Type

• Virtual
• Hybrid

Experience Level

• Minimum of 3 years of clinical experience

Education Level

• BA/BS in a health related field

Salary/Compensations

• $70k to $105k

Benefits

• Comprehensive benefits package
• Incentive and recognition programs
• Equity stock purchase
• 401k contribution
• Merit increases
• Paid holidays
• Paid Time Off
• Incentive bonus programs
• Medical
• Dental
• Vision
• Short and long term disability benefits
• 401(k) +match
• Stock purchase plan
• Life insurance
• Wellness programs
• Financial education resources

About the Company

• 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.
• 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.
• Elevance Health operates in a Hybrid Workforce Strategy.
• 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.

Equal 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.
• Applicants who require accommodation to participate in the job application process should submit the following form: Accessibility Accommodation Request Form and a member of the team will be in contact.
• 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.
• Prospective employees required to be screened under Florida law should review the education and awareness resources at HB531 | Florida Agency for Health Care Administration.