Nurse Care Mgr I

Elevance Health; United States; Hybrid; USD 38,000 - 72,000; Full time

Job summary

Elevance Health offers a 100% remote contract opportunity for a licensed RN with case management expertise to coordinate care for members with complex needs. You will assess medical necessity, develop and monitor care plans, and collaborate with providers to ensure high-quality, cost-effective care across settings.

The role requires an active RN license, multi-state licensure where applicable, and strong computer skills.

Qualifications

• HS diploma or equivalent with at least 3 years of acute care clinical experience.
• Active RN license in applicable state(s); multi-state licensure if practicing across states.
• Certification as a Case Manager preferred; URAC considerations for licensed areas.
• 3 years direct clinical care experience; 5 years preferred or equivalent background; multi-state licensure if applicable.
• Computer experience required.

Responsibilities

• Ensures medically appropriate, high-quality, cost-effective care by assessing the medical necessity of inpatient admissions, outpatient services, and level of care.
• Partners with physician clinical reviewers and/or medical directors to interpret appropriateness of care and provide clinical guidance.
• Collaborates with providers to assess consumer needs for early discharge planning and care coordination.
• Conducts clinical assessments to develop goals and care plans addressing individual needs and discharge planning.
• Monitors and evaluates effectiveness of the care management plan and makes modifications as needed.
• Telephonic outpatient case management experience and managed care involvement.

Skills

Acute care nursing experience

Case management

Multi-state licensure

Education

High School Diploma or equivalent

BS in health or human services related field preferred

Tools

Computer proficiency

Job description

Please note this is the target date and is subject to change. BCForward will send official notice ahead of a confirmed start date.

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.

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 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.

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.

Certification as a Case Manager is 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.

Computer experience a must.

Job Type: Contract

100% remote

They can live anywhere(within a reasonable commute of a PulsePoint location) , but will need compact licenses for MO, CT who are part of the compact states. NV is a Single State License state, so they will need to obtain NV (if they don't live in NV). If they only have NV license, they will need to obtain licenses for CT/MO.

Telephonic outpatient case management experience/managed care (Home Health/in‑home different than managed care).

Limited PTO requests/time off preferred for the duration of the assignment, or emergencies only.

Elevance Health operates in a Hybrid Workforce Strategy. Unless specified as primarily virtual by the hiring manager, contractors 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.

About BCForward:

Founded in 1998 on the idea that industry leaders needed a professional service, and workforce management expert, to fuel the development and execution of core business and technology strategies, BCforward is a Black‑owned firm providing unique solutions supporting value capture and digital product delivery needs for organizations around the world. Headquartered in Indianapolis, IN with an Offshore Development Center in Hyderabad, India, BCforward's 6,000 consultants support more than 225 clients globally.

BCforward champions the power of human potential to help companies transform, accelerate, and scale. Guided by our core values of People‑Centric, Optimism, Excellence, Diversity, and Accountability, our professionals have helped our clients achieve their strategic goals for more than 25 years. Our strong culture and clear values have enabled BCforward to become a market leader and best in class place to work.

BCForward is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, or protected veteran status and will not be discriminated against based on disability.

To learn more about how BCforward collects and uses personal information as part of the recruiting process, view our Privacy Notice and CCPA Addendum. As part of the recruitment process, we may ask for you to disclose and provide us with various categories of personal information, including identifiers, professional information, commercial information, education information, and other related information. BCforward will only use this information to complete the recruitment process.

This posting is not an offer of employment. All applicants applying for positions in the United States must be legally authorized to work in the United States. The submission of intentionally false or fraudulent information in response to this posting may render the applicant ineligible for the position. Any subsequent offer of employment will be considered employment at‑will regardless of the anticipated assignment duration.

Pay Rate Range

Min Pay Rate $27.26

Max Pay Rate $52.19

Currency USD

Unit hourly

Additional Pay Rate Notes

The pay range is the range BCForward in good faith believes is the range of possible compensation for this role at the time of this posting. This range may be modified in the future and actual compensation may vary from posting based on geographic location, work experience, education and/or skill level. Even within the range, the actual compensation will vary depending on the above factors as well as market/business considerations.

Benefits Information

• BCForward offers all eligible employees a comprehensive benefits package including, but not limited to major medical, HSA, dental, vision, employer‑provided group life, voluntary life insurance, short‑term disability, long‑term disability, and 401k.

The company is fully committed to ensuring equal pay opportunities for equal work regardless of gender, race, or any other category protected by federal, state, and local pay equity laws.