Managed Care Coordinator-RN Clinician

Elevance Health (Anthem); Miami (FL); Hybrid; USD 70,000 - 95,000; Full time

Job summary

Elevance Health is seeking a Managed Care Coordinator-RN Clinician in Florida to conduct telephonic or in-person assessments and coordinate care for members with complex health needs. The role emphasizes collaboration with healthcare teams and care plan development.

As an RN with 3+ years of experience, you will develop individualized plans, monitor progress, and ensure appropriate utilization of benefits. Hybrid work with required in-person training supports ongoing skill development.

Qualifications

• Requires HS diploma or equivalent and minimum 3 years of experience working with individuals with chronic illnesses, co-morbidities, and/or disabilities in a service coordination/case management role.
• Current, active, valid RN license in Florida required.
• Bilingual Spanish/English or Creole/English preferred.
• Travel to worksite and other locations as necessary.

Responsibilities

• Perform telephonic or face-to-face clinical assessments for identification, evaluation and management of members' needs.
• Identify high risk members and coordinate care with the member and health care team.
• Manage members with chronic illnesses to optimize cost-effective use of health benefits.
• Develop a care plan from thorough member history and set short/long term goals.
• Interface with Medical Directors and other clinicians to develop and revise care plans.

Skills

RN license

Bilingual Spanish/English

Education

HS diploma or equivalent

Job description

Anticipated End Date

2026-11-18

Position Title

Managed Care Coordinator-RN Clinician

Job Description

Location

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.

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 accommodation is granted as required by law.

Must be a resident of Florida

How you'll make a difference

• Responsible for performing telephonic or face-to-face clinical assessments for the identification, evaluation, coordination and management of members needs, including physical health, behavioral health, social services and long term services and supports.
• Identifies members for high risk complications and coordinates care in conjunction with the member and the health care team.
• Manages members with chronic illnesses, co-morbidities, and/or disabilities, to insure cost effective and efficient utilization of health benefits.
• Obtains a thorough and accurate member history to develop an individual care plan.
• Establishes short and long term goals in collaboration with the member, caregivers, family, natural supports, physicians; identifies members that would benefit from an alternative level of care or other waiver programs.

The RN has overall responsibility to develop the care plan for services for the member and ensures the members access to those services. May assist with the implementation of member care plans by facilitating authorizations/referrals for utilization of services, as appropriate, within benefits structure or through extra-contractual arrangements, as permissible. Interfaces with Medical Directors, Physician Advisors and/or Inter-Disciplinary Teams on the development of care management treatment plans. May also assist in problem solving with providers, claims or service issues. Directs and/or supervises the work of any LPN/LVN, LSW, LCSW, LMSW, and other licensed professionals other than an RN, in coordinating services for the member by, for example, assigning appropriate tasks to the non-RN clinicians, verifying and interpreting member information obtained by these individuals, conducting additional assessments, as necessary, to develop, monitor, evaluate, and revise the members care plan to meet the members needs, and reviewing and providing input on the non-RN clinicians performance on a regular basis.

Minimum Requirements

• Requires a HS diploma or equivalent and minimum of 3 years of experience in working with individuals with chronic illnesses, co-morbidities, and/or disabilities in a Service Coordinator, Case Management, or similar role; or any combination of education and experience, which would provide an equivalent background.
• Current, active valid and unrestricted RN license in applicable state(s) required.

Preferred skills, qualifications and experience

• HIV experience highly preferred
• Bilingual Spanish/English or Creole/English desired.
• May require state-specified certification based on state law and/or contract.
• Travels to worksite and other locations as necessary.

Job Level

Non-Management Non-Exempt

Workshift

1st Shift (United States of America)

Job Family

MED > Licensed Nurse

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, pa