Registered Nurse; RN day shift; Health Services

Nurse Case Mgr II (RN)

Virtual

This role enables associates to work virtually full-time, except for 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.

Monday – Friday, 9:00 am to 5:30 pm (PST or MST) with 2 evening shifts every week from 11:30 am to 8:00 pm (PST or MST)

The Nurse Case Mgr II (RN) is responsible for care management within the scope of licensure for members with complex and chronic care needs. Care management is conducted through screening, assessing, stratifying risk, planning, implementing (care coordination), following up, transitioning (transitional care), communicating post transition, and evaluating members. Our care model is designed to optimize member health care across the care continuum.

We provide meaningful interventions that drive improvements in clinical outcomes, productivity, and quality of life. 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.
• Assists in facilitating authorizations/referrals as appropriate within benefits structure or through extra-contractual arrangements.
• Monitors and evaluates effectiveness of the care management plan and modifies as necessary.
• Interfaces with Medical Directors and other health professionals on the development of care management treatment plans.
• Assists in problem solving with providers, claims or service issues.
• Assists with development of utilization/care management policies and procedures.

• BA/BS in a health related field and minimum of 5 years of clinical experience;
  Current, unrestricted RN license in applicable state(s) is required.
• Multi-state RN licensure is required for providing services in multiple states upon hire.
• Active California RN license is highly preferred.
• Minimum 2 years of direct Case Management experience.
• Telephonic and/or virtual nursing experience.
• Managed Care experience.
• Minimum 2 years’ experience in acute care setting.
• Experience with Microsoft Office suite and/or ability to learn new computer programs/systems/software quickly.

In addition to your salary, Elevance Health offers benefits such as a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). The Company is fully committed to ensuring equal pay opportunities for equal work regardless of gender, race, or any other category protected by federal, state, and local pay equity laws.

* The salary range is the range Elevance Health in good faith believes is the range of possible compensation for this role at the time of this posting. This range may be modified in the future and actual compensation may vary from posting based on geographic location, work experience, education, and/or skill level. No amount is wages or compensation until such amount is earned, vested, and determinable under the terms and conditions of the applicable policies and plans.

The amount and availability of any bonus, commission, benefits, or any other form of compensation and benefits that are allocable to a particular employee remains in…