Nurse Case Mgr II (US)

Elevance Health (Anthem); Louisville (KY); Hybrid; USD 70,000 - 90,000; Full time

Job summary

Elevance Health is seeking a Nurse Case Manager II in Kentucky to support members with complex and chronic care needs. This role operates primarily via telephonic care management with required in-person training sessions, and may include on-site work within a reasonable commuting distance from an Elevance Health office.

The Nurse Case Manager II assesses needs, develops and monitors care plans, coordinates authorizations and referrals, and collaborates with Medical Directors to optimize member

Qualifications

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

Responsibilities

• Assess and coordinate care plans for members with complex and chronic conditions.
• Develop, implement, and monitor care plans to optimize member health outcomes.
• Coordinate authorizations/referrals within benefits structure or through extra-contractual arrangements.
• Collaborate with Medical Directors and Physician Advisors on care management plans.
• Support discharge planning and transition of care across settings.

Skills

Care management

Assessments

Discharge planning

Interdisciplinary coordination

Education

BA/BS in health-related field

RN license

Job description

Job Title

Nurse Case Manager II

Location

Kentucky Candidates Only

Hours

1130am-8pm

Work Arrangement

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.

Job Level

Non-Management 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.

Benefits

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.

Hybrid Workforce Strategy

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.

Health Requirements

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, d