Nurse Case Manager II

Elevance Health (Anthem); Boght Corners (NY); Hybrid; USD 76,000 - 119,000; Full time

Benefits offered by this job

Comprehensive benefits package

Equity stock purchase program

401k contribution

Job summary

Elevance Health is seeking a Nurse Case Manager II to provide telephonic care management for members with complex and chronic needs. The role involves assessing, developing, coordinating, monitoring, and evaluating care plans across the care continuum with in-person training when required.

The candidate must hold a BA/BS in a health-related field, an active RN license, and at least five years of clinical experience.

Qualifications

• Requires BA/BS in a health-related field.
• Current, unrestricted RN license in applicable state(s).
• Multi-state licensure is required if providing services in multiple states.
• Certification as a Case Manager is preferred.

Responsibilities

• Ensures member access to services appropriate to their health needs.
• Conducts assessments to identify individual needs and develop a care management plan.
• Implements care plan by facilitating authorizations/referrals within benefits structure.
• Coordinates internal and external resources to meet identified needs.
• Monitors and evaluates the effectiveness of the care management plan and modifies as necessary.
• Interfacing with Medical Directors and Physician Advisors on care management plans.
• Negotiates reimbursement rates as applicable.
• Assists in problem solving with providers, claims, or service issues.
• Assists with development of utilization/care management policies and procedures.

Skills

RN license

Case management

Clinical experience

Multi-state licensure

Certification preferred

EST/CST zones

Education

BA/BS in health-related field

Job description

Anticipated End Date: 2026-09-28

Position Title: Nurse Case Manager II

Job Description: Nurse Case Manager II

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 accommodation is granted as required by law.

The Nurse Case Manager II is responsible for 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.

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.
• 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 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.
• Compact license is preferred.
• Case management experience is strongly preferred.
• Must reside in EST/CST zones

For URAC accredited areas the following applies: Requires a BA/BS and minimum of 5 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 locations, the salary* range for this specific position is $75,680 to $119,196

Location: New York, Virginia

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 offered for this specific position is based on a number of legitimate, non-discriminatory factors set by the Company. 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.

* 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

Job Family: MED > Licensed Nurse

Who We Are

Elevance Health is a health company

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.