Nurse Case Manager II

Elevance Health (Anthem); Atlanta (GA); Ibrido; USD 90.000 - 110.000; Tempo pieno

Descrizione del lavoro

Elevance Health is seeking a Nurse Case Manager II to support member health needs in a largely remote role with required in-person training and occasional office visits. This position emphasizes flexibility, autonomy, and hands-on onboarding to develop critical care management skills.

Ideal candidates hold a BSN/BA in a health-related field with 5+ years of clinical experience, a current RN license, and multi-state licensure.

Competenze

• BA/BS in a health-related field; minimum 5 years of clinical experience.
• Current, unrestricted RN license; multi-state licensure required.
• Experience in case management or care coordination preferred.

Mansioni

• Ensure member access to appropriate health services.
• Conduct assessments to identify needs and create care plans.
• Facilitate authorizations and referrals within benefits or through extra-contractual arrangements.
• Coordinate internal and external resources to meet identified needs.
• Monitor and evaluate care plan effectiveness and modify as needed.
• Collaborate with Medical Directors and Physician Advisors on care plans.
• Negotiate reimbursement rates when applicable.
• Assist with problem solving for providers, claims, or service issues.
• Assist in development of utilization/care management policies and procedures.

Conoscenze

Care coordination

Nursing

Clinical assessment

Multistate licensure

Communication

Formazione

BA/BS in health-related field

Descrizione del lavoro

Anticipated End Date: 2026-11-02

Position Title: Nurse Case Manager II

Job Description:

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.

This position is not eligible for employment-based sponsorship.

Hours

Monday-Friday EST, with 1 late evening 11:30am -8:00pm per week. 1 rotating Friday late night (Approx 1-2 times per year)

Licensure

***This position will service members in different states; therefore Multi-State Licensure will be required.

Responsibilities

• 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.
• Assists with development of utilization/care management policies and procedures.

Minimum Requirements

• Requires BA/BS in a health-related field and minimum of 5 years of clinical experience; or any combination of education and experience, which would provide an equivalent background.
• Current, unrestricted RN license in applicable home state required.
• Multi-state licensure is required if this individual is providing services in multiple states.

Preferred Skills, Capabilities and Experience

• Certification as a Case Manager is preferred.

Job Details

• Job Level: Non-Management Exempt
• Workshift: 1st Shift (United States of America)
• Job Family: MED > Licensed Nurse

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.

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