Nurse Case Manager II

Elevance Health (Anthem); Rocky Hill (CT); Hybrid; USD 85,000 - 110,000; Full time

Job summary

Elevance Health in Connecticut is seeking a Nurse Case Manager II to assess medical necessity and coordinate patient care across inpatient and outpatient settings. This hybrid in-office 1-2 days per week role combines collaboration with clinicians and flexible work arrangements.

The position requires RN licensure, acute care or discharge planning experience, and familiarity with managed care processes. You will develop care plans, monitor outcomes, and contribute to policy and team initiatives.

Qualifications

• Requires HS diploma or equivalent with a RN license.
• AS or BS in nursing preferred; Case Manager certification preferred.
• Experience in acute care, home health, or discharge planning.
• Knowledge of medical management, member contracts, and benefits.

Responsibilities

• Assess medical necessity and appropriateness of care for admissions and services.
• Collaborate with physicians and medical directors to plan interventions.
• Coordinate with providers for discharge planning and early identification.
• Develop and implement individualized care plans and monitor outcomes.
• Participate in policy development for utilization and care management.
• Lead or join intradepartmental projects and teams.

Skills

RN licensure

Case management

Clinical assessment

Interdisciplinary collaboration

Education

HS diploma or equivalent

AS or BS in nursing

Case Manager certification (preferred)

Job description

Anticipated End Date

2026-09-25

Position Title

Nurse Case Manager II

Job Description

Location: This role requires associates to be in-office 1 - 2 days per week, fostering collaboration and connectivity, while providing flexibility to support productivity and work-life balance. This approach combines structured office engagement with the autonomy of virtual work, promoting a dynamic and adaptable workplace. 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.

How you'll make a difference

• Ensures medically appropriate, high quality, cost effective care through assessing the medical necessity of inpatient admissions, outpatient services, out of network services, and appropriateness of treatment setting and level of care.
• Partners with physician clinical reviewers and/or medical directors to interpret appropriateness of care, intervention planning, and general clinical guidance.
• Collaborates with providers to assess consumer needs for early identification of and proactive planning for discharge.
• Conducts clinical assessment to develop goals that address individual needs in order to develop a care plan; implements and coordinates a care plan.
• Monitors and evaluates effectiveness of the care management plan and modifies as necessary.
• Assists with development of utilization/care management policies and procedures.
• Participates in or leads intradepartmental teams, projects, and initiatives.

Minimum Requirements

Requires a HS diploma or equivalent and a minimum of 3 years of acute care clinical experience, condition specific clinical experience, home health/discharge planning experience and a minimum of 1 year in a Nurse Care Mgr I role or equivalent experience; or any combination of education and experience, which would provide an equivalent background. Current, valid active unrestricted RN license in applicable state(s) required. Multi-state licensure is required if this individual is providing services in multiple states.

Preferred skills, qualifications and experiences

• AS or BS in nursing preferred.
• Certification as a Case Manager is preferred. Participation in the American Association of Managed Care Nurses preferred.
• Prior managed care experience preferred.
• Knowledge of medical management process and ability to interpret and apply member contracts, member benefits, and managed care products strongly preferred.
• Understanding barriers in rural health highly preferred.

Job Level

Non-Management Non-Exempt

Job Family

MED > Licensed Nurse

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 vacci