Nurse Case Manager I

Elevance Health (Anthem); Boght Corners (NY); Remote; USD 67,000 - 121,000; Full time

Benefits offered by this job

Comprehensive benefits package

Job summary

Elevance Health invites applications for a Nurse Case Manager I position. This remote role enables full-time telework with occasional in-person training, accommodating a flexible schedule within a defined office-access policy.

The nurse will develop, coordinate, monitor, and evaluate care plans for members with complex needs, performing telephonic discharge planning from hospitals as needed. Requirements include a BA/BS in a health-related field, 3+ years of clinical experience, and an active RN

Qualifications

• Requires BA/BS in a health-related field and minimum of 3 years of clinical experience.
• Current, unrestricted RN license in applicable state(s) required.
• Multi-state licensure required if providing services in multiple states.
• Certification as Case Manager preferred; compact RN license preferred.

Responsibilities

• Ensure member access to services and develop a care management plan.
• Coordinate authorizations/referrals within benefits structure and through extra-contractual arrangements.
• Coordinate internal and external resources to meet identified needs.
• Monitor and evaluate care management plans and liaise with Medical Directors and Physician Advisors.
• Assist in problem solving with providers, claims or service issues.

Skills

RN license

Multi-state licensure

Case management certification (pref)

Education

BA/BS in health-related field

Job description

Position Title

Nurse Case Manager I

Work location

Virtual

Job Description

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.

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.

The Nurse Case Manager I is responsible for performing care management within the scope of licensure for members with complex and chronic care needs by assessing, developing, implementing, coordinating, monitoring, and evaluating care plans designed to optimize member health care across the care continuum. Performs duties telephonically such as at hospitals for discharge planning.

Work hours

Monday - Friday, 8am-4:30pm EST, with one 11:30am-8pm EST shift every other week.

Primary duties

• Ensures member access to services appropriate to their health needs. Conducts assessments to identify individual needs and a specific care management plan to address objectives and goals as identified during assessment.
• Implements care plan by facilitating authorizations/referrals as appropriate within benefits structure or through extra-contractual arrangements.
• Coordinates internal and external resources to meet identified needs.
• Monitors and evaluates effectiveness of the care management plan and modifies as necessary. Interfaces with Medical Directors and Physician Advisors on the development of care management treatment plans.
• Assists in problem solving with providers, claims or service issues.

Minimum requirements

• Requires BA/BS in a health related field and minimum of 3 years of clinical experience; or any combination of education and experience, which would provide an equivalent background.
• Current, unrestricted RN license in applicable state(s) required.
• Multi-state licensure is required if this individual is providing services in multiple states.

Preferred qualifications, skills, and experiences

• Certification as a Case Manager and a BS in a health or human services related field preferred.
• Compact RN license is preferred.

URAC accredited areas

For URAC accredited areas the following applies: Requires BA/BS and 3 years of clinical care experience; or any combination of education and experience, which would provide an equivalent background. Current and active RN license required in applicable state(s). Multi-state licensure is required if this individual is providing services in multiple states.

Salary

For candidates working in person or virtually in the below locations, the salary* range for this specific position is $67,200 to $120,960

Location(s): New York, Virginia

Benefits

• In addition to your salary, Elevance Health offers benefits such as a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements).

* The salary range is the range Elevance Health 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. No amount is wages or compensation until such amount is earned, vested, and determinable under the terms and conditions of the applicable policies and plans. The amount and availability of any bonus, commission, benefits, or any other form of compensation and benefits that are allocable to a particular employee remains in the Company's sole discretion unless and until paid and may be modified at the Company's sole discretion, consistent with the law.

Job Level

Non-Management Exempt

Workshift

1st Shift (United States of America)

Job Family

MED > Licensed Nurse

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.

Who We Are

Elevance Health is a health company dedicated to improving lives and communities - and making hea