Nurse Case Manager I - Oncology

Elevance Health; St. Louis (MO); Remote; USD 65,000 - 90,000; Full time

Benefits offered by this job

Sign-on Bonus $3000

Job summary

Elevance Health seeks a Nurse Case Manager I - Oncology to manage complex patient care needs across the care continuum. This remote role supports assessments, care plan development, and coordination with hospitals and providers, including discharge planning.

Responsibilities include monitoring care plan effectiveness, collaborating with medical directors, and facilitating referrals within benefits structures. Oncologic experience is preferred; hybrid in-person training may be required.

Qualifications

• Requires BA/BS in a health related field and a minimum of 3 years of clinical experience.
• RN license in applicable state(s) is required and multi-state licensure is needed for multi-state service.

Responsibilities

• Perform care management for members with complex/chronic needs by assessing, developing, implementing, coordinating, monitoring and evaluating care plans.
• Conduct telephonic or on-site discharge planning and coordination with hospitals and providers.
• Coordinate internal/external resources and authorize referrals as appropriate.
• Monitor effectiveness of care plans and adjust as needed.
• Collaborate with Medical Directors and Physician Advisors on care plans.
• Negotiate appropriate rates of reimbursement when applicable.
• Assist in problem solving with providers, claims, or service issues.

Education

BA/BS in health related field

Job description

Position Title: Nurse Case Manager I - Oncology

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; 9:00am - 5:30pm and 9:30am - 6:00pm 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