Nurse Care Manager I

The Elevance Health Companies, Inc.; Puerto Rico; Hybrid; USD 60,000 - 90,000; Full time

Job summary

The Nurse Care Manager I role is based in Puerto Rico with virtual full-time work and required in-person training sessions. This position supports care management for members with complex needs, collaborating with providers to optimize health outcomes.

Multistate licensure is preferred for cross-state services. Ideal candidates possess an RN license, a bilingual English/Spanish capability, and at least 3 years of acute care experience, with strong assessment and care planning skills for diverse

Qualifications

• Requires HS diploma or equivalent and a minimum of 3 years of acute care clinical experience.
• Current, active valid unrestricted RN license in applicable state(s) required.
• Multi-state licensure is required if this individual is providing services in multiple states.

Responsibilities

• Assess medical necessity of inpatient admissions, extensions of stay, and outpatient services to ensure appropriate level of care.
• Collaborate with physician reviewers/medical directors to interpret care appropriateness and planning.
• Work with providers to identify discharge needs and proactive planning.
• Conduct clinical assessments to develop goals and care plans for individual needs.
• Monitor and adjust care management plans based on outcomes.

Skills

RN licensure

Bilingual EN/ES

Acute care experience

Education

HS diploma or equivalent

Job description

Anticipated End Date: 2026-10-14
Position Title: Nurse Care Manager I

Job Location and Work Schedule

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. This position will be based in Puerto Rico. 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 rotating 8-hour shifts between 8:30 am - 8:30 pm (ET), Monday through Friday. Additional hours, including weekends or holidays, may be required based on operational needs.

Company Overview

Carelon Global Solutions (CGS), a fully owned subsidiary of Elevance Health, is a healthcare solutions company that is simplifying complex operational processes to improve the health of the healthcare system. Our Puerto Rico location operates a bilingual Spanish and English call center, providing clear and precise answers to customer queries.

Role Overview

The Nurse Care Manager I is responsible for collaborating with healthcare providers and/or consumer to drive personalized health management and improve health outcomes for optimal consumers. Performs care management activities within the scope of licensure for members with complex and chronic care needs.

Primary Duties

• Ensures medically appropriate, high-quality, cost-effective care through assessing the medical necessity of inpatient admissions and extensions of stay, outpatient services, out of network services, and appropriateness of treatment setting and level of care.
• Partners with physician clinical reviewers and/or medical directors to interpret appropriateness of care, intervention planning, and general clinical guidance.
• Collaborates with providers to assess consumer needs for early identification of and proactive planning for discharge.
• Conducts clinical assessment to develop goals that address individual needs in order to develop and implement a care plan.
• Monitors and evaluates effectiveness of the care management plan and modifies as necessary.

Minimum Requirements

Requires a HS diploma or equivalent and a minimum of 3 years of acute care clinical experience; or any combination of education and experience, which would provide an equivalent background. Current, active valid unrestricted RN license in applicable state(s) required. Multi-state licensure is required if this individual is providing services in multiple states.

Preferred Skills, Capabilities, and Experiences

• Fully Bilingual (English & Spanish), Must be able to write, read and speak both languages in a proficiency level preferred.
• AS or BS in nursing is strongly preferred.
• NCLEX Certification or current unrestricted RN license from one of the 50 states of the United States is highly preferred.
• Home health/discharge planning experience preferred.
• Certification as a Case Manager or a BS in a health or human services related field also 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. Requires 3 years full-time equivalent of direct clinical care experience to the consumer, 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, Multi-state licensure is required if this individual is providing services in multiple states. Certification as a Case Manager or a BS in a health or human services related field also preferred.

Job Level / Workshift / Job Family

Job Level: Non-Management Non-Exempt Workshift: Job Family: MED > Licensed Nurse

Recruiting Policy

We ask for no unsolicited resumes. Please note 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.

Company Culture and Benefits

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 disability benefits, 401(k) +match, stock purchase plan, life insurance, wellness programs and financial education resources, to name a few.

Elevance Health operates in a Hybrid Workforce Strategy. Unless specified as primarily virtual by the hiring manager, associates are required to work at an Elevance Health location at least once per week, and potentially several times per week. Specific requirements and expectations for time onsite will be discussed as part of the hiring process. The health of our associates and communities is a top priority for Elevance Health. We require all new candidates in certain patient/member-facing roles to become vaccinated against COVID-19 and Influenza. If you are not vaccinated, your offer will be rescinded unless you provide an acceptable explanation. Elevance Health will also follow all relevant federal, state and local laws. Elevance Health is an Equal Employment Opportunity employer, and all qualified applicants will receive consideration for employment without regard to age, citizenship status, color, creed, disability, ethnicity, genetic information, gender (including gender identity and gender expression), marital status, national origin, race, religion, sex, sexual orientation, veteran status or any other status or condition protected by applicable federal, state, or local laws.

Additional Details

Applicants who require accommodation to participate in the job application process should submit the following form: Accessibility Accommodation Request Form and a member of the team will be in contact. Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state, and local laws, including but not limited to the Los Angeles County Fair Chance Ordinance and the California Fair Chance Act. Prospective employees required to be screened under Florida law should review the education and awareness resources at HB531 | Florida Agency for Health Care Administration. NOTE: Workday keeps job postings active through 11:59:59 PM on the day before the listed end date. Example: If the end date is 3/13, the posting will automatically come down on 3/12 at 11:59:59 PM. In other words — the job is posted until 3/13, not through 3/13. Elevance Health is a health company dedicated to improving lives and communities – and making healthcare simpler. Previously known as Anthem, Inc., we have evolved into a company focused on whole health and updated our name to better reflect the direction the company is heading. Join our Talent Community and stay connected with company news, information, and future job opportunities. Fueled by our bold purpose to improve the health of humanity, we are transforming from a traditional health benefits organization into a lifetime trusted health partner.Our nearly 100,000 associates serve approximately 100M+ people, at every stage of health. We address a full range of needs with an integrated whole health approach, powered by industry-leading capabilities and a digital platform for health. Elevance Health is an Equal Employment Opportunity employer, and all qualified applicants will receive consideration for employment without regard to age, citizenship status, color, creed, disability, ethnicity, genetic information, gender (including gender identity and gender expression), marital status, national origin, race, religion, sex, sexual orientation, veteran status or any other status or condition protected by applicable federal, state, or local laws. Applicants who require accommodation to participate in the job application process should submit the following form: Accessibility Accommodation Request Form and a member of the team will be in contact. Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state, and local laws, including, but not limited to, the Los Angeles County Fair Chance Ordinance and the California Fair Chance Act. Prospective employees required to be screened under Florida law should review the education and awareness resources at HB531 | Florida Agency for Health Care Administration Please visit the Contract Worker Community Page. Elevance Health is an Equal Opportunity Employer/Disability/Veterans.