Nurse Case Mgr II

Elevance Health; Louisville (KY); Remote; USD 65,000 - 90,000; Full time

Job summary

Elevance Health is seeking a Nurse Case Manager II to support members with complex health needs. The role is virtual full-time with in-person training and occasional office visits required for onboarding.

Candidates must have multi-state licensure and an active RN license, with experience in case and utilization management. The position involves coordinating care plans, authorizations, and collaborating with medical directors across multiple states including IL, KY, MO, VA, WI, and OH.

Qualifications

• Current, unrestricted RN license in applicable state.
• Multi-state licensure required if servicing multiple states.
• 2+ years of acute care experience.
• Case management and utilization management experience.
• Certification as a Case Manager preferred.
• Proficiency with Microsoft Office and quick learning of new systems.

Responsibilities

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

Skills

Case Management

Utilization Management

Case Manager Certification

Acute care experience

MS Office

Email management

Education

RN licensed

Multi-state licensure

Job description

Nurse Case Manager II

Hours: M-F 9:30 AM-6:30 PM EST

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. Alternate locations may be considered if candidatesresidewithin 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.

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. Perform 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.
• Implement 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.
• Negotiate 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:

• Current, unrestricted RN license in applicable state required.
• Multi-state licensure is required if this individual provides services in multiple states.

Preferred Capabilities, Skills and Experiences:

• Case Management experience.
• Utilization Management experience.
• Certification as a Case Manager.
• Minimum 2 years’ experience in acute care setting.
• Experience with (Microsoft Office) and/or ability to learn new computer programs/systems/software quickly.
• Ability to manage, review and respond to emails/instant messages in a timely fashion.

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

Location(s): Illinois, Kentucky, Missouri, Virginia, Wisconsin, Ohio

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 should submit the Accessibility Accommodation Request Form and a member of the team will be in contact.

Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state, and local laws, including, but not limited to, the Los Angeles County Fair Chance Ordinance and the California Fair Chance Act.

Prospective employees required to be screened under Florida law should review the education and awareness resources at HB531 | Florida Agency for Health Care Administration.