Nurse Case Mgr II (US)

Elevance Health (Anthem); Boght Corners (NY); Hybrid; USD 79.000 - 119.000; Vollzeit

Benefits dieser Stelle

Benefits package

Equity stock purchase plan

401k contributions

Zusammenfassung

Elevance Health in New York is seeking a Nurse Case Manager II (US) to perform care management for members with complex and chronic needs, assessing, developing, implementing, coordinating, monitoring and evaluating care plans across the care continuum. This role may involve telephonic or on-site work, including discharge planning in hospitals.

The position requires a BA/BS in a health-related field and a current, unrestricted RN license in the applicable state(s), with multi-state licensure

Qualifikationen

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

Aufgaben

• Ensures member access to services and conducts assessments to identify needs and goals.
• Implements care plan by facilitating authorizations/referrals within benefits or extra-contractual arrangements.
• Coordinates internal and external resources to meet identified needs.
• Monitors and evaluates effectiveness of the care management plan and adjusts as needed.
• Interacts with Medical Directors and Physician Advisors on care plans.
• Negotiates rates of reimbursement, as applicable.
• Assists with problem solving with providers, claims or service issues.
• Contributes to development of utilization/care management policies and procedures.

Kenntnisse

RN license

5+ years clinical experience

Case management

Multi-state licensure

Communication skills

Ausbildung

BA/BS in health related field

BS in health or human services related field preferred

Jobbeschreibung

Anticipated End Date: 2026-10-21

Position Title: Nurse Case Mgr II (US)

Job Description: Nurse Case Manager II

Hours: M-F 8am-4:30 PM EST with 2-3 late evenings a month 11:30am-8pm

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 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 an accommodation is granted as required by law.

The Nurse Case Manager II is responsible for performing 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 or on-site such as at hospitals for discharge planning.

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 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 $79,464 to $119,196

Location(s): New York

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

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.

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