Nurse Case Manager I

Elevance Health; St. Louis (MO); Hybrid; USD 55,000 - 75,000; Full time

Benefits offered by this job

Sign-on bonus

Job summary

Elevance Health in St. Louis, MO is seeking a Nurse Case Manager I to manage care across the continuum by assessing, developing, implementing, coordinating and evaluating care plans. Duties include telephonic work or on-site discharge planning to ensure appropriate member access to services.

The role supports a hybrid/virtual work arrangement with weekly in-office requirements and training sessions. Must have BA/BS in health-related field and an active RN license, with multi-state licensure

Qualifications

• BA/BS in a health-related field and minimum of 3 years of clinical experience; RN license required.
• Multi-state licensure required if providing services in multiple states.
• Certification as Case Manager is preferred.

Responsibilities

• Performs care management within licensure scope for members with complex and chronic care needs.
• Assesses, develops, implements, coordinates, monitors, and evaluates care plans.
• Operates telephonically or on-site (e.g., hospital discharge planning) to optimize member health.
• Interfaces with Medical Directors and Physician Advisors on care plans.
• Negotiates reimbursement rates as applicable within benefits or contracts.
• Coordinates internal and external resources to meet identified needs.

Skills

Care coordination

Assessment

Discharge planning

Telephonic care management

Education

BA/BS in health-related field

RN license (US)

Multi-state licensure

Job description

Sign-on Bonus: $3000

Position Title: Nurse Case Manager I

Sign-on Bonus: $3000

Location: 100 S 4th Street St. Louis, MO

Virtual: 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 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.

Schedule: Monday - Friday 8:30am - 5:00pm CST

The Nurse Case Manager I (US) will be 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. 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.

Preferred Skills, Capabilities And Experiences

• Certification as a Case Manager is preferred.
• Certification as a Case Manager and a BS in a health or human services related field preferred.
• 4 years of Oncology experience 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.