Nurse Case Manager II

Anticipated End Date:

Position Title:

Telephonic Nurse Case Manager II

Sign on Bonus: $3000.

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

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.

Hours:
Monday - Friday 8 - 5 pm CST.

***** This position will service members in different states; therefore, Multi‑State Licensure will be required.

The Telephonic
Nurse Case Manager II is 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.

• 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. Assists with development of utilization/care management policies and procedures.

• Requires BA/BS in a health related field and minimum of 5 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.

• Case Management experience is preferred.

• Minimum 2 years’ experience in acute care setting is preferred.

• Managed Care experience is preferred.

• Ability to talk and type at the same time is preferred.

• Demonstrate critical thinking skills when interacting with members is preferred.

• Experience with Microsoft Office and/or ability to learn new computer programs/systems/software quickly is preferred.

• Ability to manage, review and respond to emails/instant messages in a timely fashion is preferred.

Job Level:

Workshift:

Job Family:

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.

We offer a range of 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…