Nurse Case Manager II

Elevance Health; Costa Mesa (CA); Remote; USD 73,000 - 127,000; Full time

Job summary

A health insurance company is seeking a Nurse Case Manager II to manage care for members with complex health needs. The position offers virtual work options with a flexible schedule and requires a BA/BS in a health-related field along with an RN license. Ideal candidates will possess strong clinical experience and problem-solving skills.

Benefits

Comprehensive benefits package

401(k) contribution

Incentive programs

Qualifications

• Requires BA/BS in a health-related field and minimum of 5 years of clinical experience.
• Current, unrestricted RN license in applicable state(s) required.
• Certification as a Case Manager is preferred.

Responsibilities

• Responsible for care management within the scope of licensure for members.
• Conduct assessments to identify individual needs and create care management plans.
• Coordinate internal and external resources to meet identified needs.

Skills

Clinical experience

Care management

Problem Solving

Education

BA/BS in a health-related field

Current, unrestricted RN license

Job description

Overview

Anticipated End Date: 2025-10-19

Position Title: Nurse Case Manager II

Job Description:

Nurse Case Manager II

Location(s): California, Colorado, Nevada, Washington State

Virtual: This role enables associates to work virtually full-time, with the exception of 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.

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.

Work Hours: Monday - Friday. For three days, employees will work virtually from 9:00 AM to 5:30 PM, and for two days, they will work evening shifts from 11:30 AM to 8:00 PM (local time)

Responsibilities

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. Duties may include care coordination at hospitals for discharge planning and performing tasks telephonically or on-site where needed. How you will make an impact:

Primary duties may include but are not limited to:

• Ensures member access to services appropriate to their health needs.
• Conducts assessments to identify individual needs and create specific care management plans with objectives and goals identified during assessment.
• Implements care plans by facilitating authorizations/referrals as appropriate within the benefits structure or through extra-contractual arrangements.
• Coordinates internal and external resources to meet identified needs.
• Monitors and evaluates the 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 providing 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. Certification as a Case Manager is preferred. 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 providing 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 and a BS in a health or human services related field preferred
• California license is strongly preferred

Salary and Location

For candidates working in person or virtually in the below location(s), the salary range for this specific position is $73,280.00 to $126,408

Locations: California, Colorado, Nevada, Washington State

Benefits and About Elevance Health

In addition to salary, Elevance Health offers benefits such as a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution. The salary offered is based on legitimate, non-discriminatory factors. Elevance Health is committed to equal pay opportunities for equal work regardless of gender, race, or any other protected category 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. No amount is considered wages or compensation until earned, vested, and determinable under 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 at 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

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.

About Us and How We Work

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 may contact e relevancehealthjobssupport at relevancehealth.com for assistance. Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state, and local laws, including the Los Angeles County Fair Chance Ordinance and the California Fair Chance Act.