Nurse Case Manager I

Anthem Blue Cross & Blue Shield; Columbus (GA); Remote; USD 67,000 - 105,000; Full time

Job summary

Elevance Health is seeking a Nurse Case Manager I to perform comprehensive care management for members with complex and chronic needs. The role involves assessing, designing, coordinating, and evaluating care plans, delivered telephonically or on-site, including discharge planning.

The position focuses on ensuring access to appropriate services, coordinating resources, and collaborating with Medical Directors and Physician Advisors.

Qualifications

• BA/BS in health related field and minimum of 3 years of clinical experience.
• Current, unrestricted RN license in applicable state(s).
• Multi-state licensure is required if providing services in multiple states.

Responsibilities

• Assess, develop, implement, coordinate, monitor, and evaluate care plans for members with complex and chronic needs.
• Perform care management telephonically or on-site, including discharge planning.
• Ensure access to services and coordinate internal/external resources.
• Interface with Medical Directors and Physician Advisors on treatment plans.
• Negotiates rates of reimbursement, as applicable.
• Assists in problem solving with providers, claims or service issues.
• Monitor and modify care plans based on effectiveness.

Skills

Nursing

Care coordination

Clinical assessment

Communication

Problem solving

Team collaboration

Education

BA/BS in health related field

RN license

Multi-state licensure

Job description

Anticipated End Date: 2026-10-12

Position Title: Nurse Case Manager I

Job Description:

Nurse Case Manager I

Location:

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 an accommodation is granted as required by law.

Schedule

This position will work an 8-hour from shift 8:00 am - 8:00 pm (EST), Monday to Friday. Additional hours may be necessary based on company needs.

The Elevance Health Companies, Inc.

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 or on-site such as at hospitals for discharge planning.

How you will make an impact.

• 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.
• Negotiates rates of reimbursement, as applicable.
• 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 Skills, Capabilities, and Experiences:

• Certification as a Case Manager is preferred.

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. Certification as a Case Manager and a BS in a health or human services related field preferred.

For candidates working in person or virtually in the below location(s), the salary* range for this specific position is $67k to $105k.

Locations:

Latham, NY & Norfolk , VA.

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).

We offer a range of market-competitive total rewards that include merit increases, paid holidays, Paid Time Off, and