Manager I Care Management

Elevance Health (Anthem); San Juan (PR); Hybrid; USD 90,000 - 115,000; Full time

Job summary

Elevance Health in San Juan, Puerto Rico, is seeking a Manager I Care Management to lead care management operations in a hybrid setting. The role requires a BS in Nursing, an active RN license, and strong clinical leadership experience to drive program quality and risk management.

The incumbent will oversee policy adherence, budget targets, and staff development while working 3 days in-office and 2 days remote. Fluency in English and Spanish is highly preferred and URAC requirements may apply.

Qualifications

• Requires BS in Nursing and a minimum of 5 years of acute care clinical experience
• Current unrestricted RN license in applicable state(s)
• URAC accreditation related requirements may apply and certification as Case Manager is preferred

Responsibilities

• Assesses medical necessity of outpatient services and appropriateness of treatment settings
• Oversees process improvement, quality assurance, and adherence to medical policy and standards
• Ensures prevention and health management program accreditation standards are achieved
• Participates in establishing strategic plans and objectives and develops related policies
• Participates in managing annual budget productivity targets
• Hires, trains, coaches, and evaluates performance of direct reports

Skills

Bilingual English & Spanish

Education

BS in Nursing

RN license

Job description

Manager I Care Management

Anticipated End Date: 2026-10-06

Location: San Juan, Puerto Rico.

Hybrid 2: This role requires associates to be in-office 3 days per week, fostering collaboration and connectivity, while providing flexibility to support productivity and work-life balance. This approach combines structured office engagement with the autonomy of virtual work, promoting a dynamic and adaptable workplace. This position will be based on: 1001 San Roberto St, Ste 101, 401 & 501, San Juan, PR.

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.

Schedule: This position will work 8-hour shifts Monday through Friday and must be available to work within the operational hours of 8:00 a.m. to 6:00 p.m. (AST). Additional hours, including weekends or holidays, may be required based on operational needs.

Axium Healthcare Puerto Rico, a Carelon company, is a clinical pharmacy that offers highly individualized and comprehensive total life care programs to patients and their families. Serving Puerto Rico since 2007, the organization blends a high-touch, caring patient experience with specialized clinical knowledge, personalized care programs, and administrative expertise.

How you will make an impact:

Primary duties may include, but are not limited to:

• Assesses the medical necessity of outpatient services, out of network services, and appropriateness of treatment setting and level of care.
• Oversees process improvement, quality assurance, and adherence to applicable medical policy, care management best practices, relevant clinical standards, and member contract.
• Ensures prevention and health management program accreditation standards are achieved.
• Participates in establishing strategic plans and objectives; aligning, developing, and implementing functional area policies and procedures to support strategic plans and objectives.
• Participates in establishing and managing the annual budget productivity targets.
• Hires, trains, coaches, counsels, and evaluates performance of direct reports.

Minimum Requirements:

Requires BS in Nursing and minimum of 5 years of acute care clinical experience; or any combination of education and experience, which would provide an equivalent background.

Current unrestricted RN license in applicable state(s) required.

Preferred Skills, Capabilities, and Experiences:

• Fully Bilingual (English & Spanish), Must be able to write, read and speak both languages in a proficiency level.
• Certification as a Case Manager preferred.
• Additional schooling or certifications preferred.

For URAC accredited areas, the following applies: Current and active RN license required in applicable state(s) that allows for an independent assessment to be conducted within their scope of practice. Managers who have directly supervised the case management process for 3 or more years are expected to hold a certification as a case manager and meet continuing education requirements to maintain licensure and certification. Requires minimum of 3 years full-time equivalent of direct clinical care experience to the consumer, and minimum of 5 years full-time equivalent of direct clinical care experience to the consumer preferred, or any combination of education and experience, which would provide an equivalent background. Certification as a Case Manager and a BS in a health or human services related field preferred. For URAC accredited areas, the following professional competencies apply: Associates in this role are expected to have strong oral, written and interpersonal communication skills, problem-solving skills, facilitation skills, and analytical skills.

Job Level:

Manager

Job Family:

MED > Licensed Nurse

Please be advised that Elevance Health only accepts resumes for compensation from agencies that have a signed agreement with Elevance Health. Any unsolicited resumes, including those submitted to hiring managers, are deemed to be the property of Elevance Health.

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