Nurse Case Manager II - California

Elevance Health (Anthem); California; Hybrid; CAD 81,000 - 127,000; Full time

Benefits offered by this job

Comprehensive benefits

Equity stock purchase program

401k contribution

Job summary

Elevance Health is seeking a Nurse Case Manager II in California to assess members, develop tailored care plans, and coordinate authorizations, referrals, and resources across the care team. The role emphasizes collaboration with Medical Directors and Physician Advisors to optimize outcomes.

Candidates should hold a BA/BS in a health-related field, have 5+ years of clinical experience, and possess an active RN license.

Qualifications

• Requires BA/BS in a health-related field and 5+ years of clinical experience.
• Current, unrestricted RN license in applicable state(s).
• Multi-state licensure if providing services in multiple states.

Responsibilities

• Ensures member access to services appropriate to health needs.
• Conducts assessments and develops care plans to address objectives.
• Implements care plans via authorizations/referrals within benefits.
• Coordinates internal and external resources to meet needs.
• Monitors and evaluates care management effectiveness and updates plans.
• Interfaces with Medical Directors and Physician Advisors on care plans.
• Negotiates reimbursement rates where applicable.
• Assists with problem solving for providers, claims or service issues.
• Contributes to utilization/care management policy development.

Skills

RN license

Clinical experience

Case management

Education

BA/BS in health related field

Job description

Nurse Case Manager II - California

Location: State of California

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.

Schedule: 9-5:30 Pacific time with 1-2 even shifts (11:30-8 Pacific time) per week (one late shift per month must be Friday).

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.

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.

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.

Locations:

California

For candidates working in person or virtually in the below location(s), the salary* range for this specific position is $41.84/hr to $65.50 /hr

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 considered to be 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, paid time off, stock, 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 Non-Exempt

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