Hybrid Nurse Case Manager I — Care Coordination

Elevance Health (Anthem); St. Louis (MO); Hybrid; USD 70,000 - 90,000; Full time

Job summary

Elevance Health is seeking a Nurse Case Manager I to assess, develop, implement, and coordinate care plans for members with complex and chronic needs, ensuring optimal care across the continuum. Duties may be telephonic or on-site for discharge planning and coordination with providers.

The role requires clinical experience and a RN license, with hybrid work and periodic in-person onboarding and training. Location-flexible within the United States, with travel as needed.

Qualifications

• Requires BA/BS in a health related field and minimum of 3 years of clinical experience.
• Current, unrestricted RN license in applicable state(s) required.
• Multistate licensure is required if this individual is providing services in multiple states.

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.

Skills

RN license

Clinical experience

Care management

Multistate licensure

Education

BA/BS in health-related field

Job description

Elevance Health is seeking a Nurse Case Manager I to assess, develop, implement, and coordinate care plans for members with complex and chronic needs, ensuring optimal care across the continuum. Duties may be telephonic or on-site for discharge planning and coordination with providers.

The role requires clinical experience and a RN license, with hybrid work and periodic in-person onboarding and training. Location-flexible within the United States, with travel as needed.