Nurse Care Manager I

Elevance Health; San Juan (PR); Hybrid; USD 65,000 - 90,000; Full time

Job summary

Elevance Health seeks a Nurse Care Manager I in Puerto Rico. This hybrid/virtual role supports flexible scheduling with required in-person training and the goal of driving personalized health management for members with complex needs.

Requirements include a HS diploma or equivalent with 3+ years acute care experience, an active RN license (multistate preferred), and bilingual English/Spanish capabilities to support a bilingual call center environment.

Qualifications

• HS diploma or equivalent with ≥3 years acute care clinical experience.
• Current, active RN license in applicable state(s).
• Multi-state licensure if providing services in multiple states.

Responsibilities

• Collaborates with providers to assess consumer needs for discharge planning.
• Develops goals to address individual needs and care plans.
• Monitors and evaluates the care management plan and updates as needed.
• Assess medical necessity for inpatient admissions and services.
• Interprets clinical guidance with physician reviewers and medical directors.

Skills

Bilingual English

Spanish proficiency

RN license

Acute care experience

Clinical assessment

Education

HS diploma or equivalent

AS or BS in nursing

NCLEX Certification

Job description

Nurse Care Manager I

Location: This role enables associates to workvirtually 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 candidatesresidewithin 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.

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.

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.

How You Will Make an Impact

Primary duties may include, but are not limited to:

• 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.

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 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, 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. Applicants who require accommodation to participate in the job application process should submit the 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.