Nurse Case Mgr Sr

Elevance Health (Anthem); Boght Corners (NY); Hybrid; USD 84,000 - 126,000; Full time

Job summary

Elevance Health seeks a Senior Nurse Case Manager to coordinate care for members with complex and chronic needs. The role conducts telephonic care management, develops care plans, and collaborates with Medical Directors to ensure access to appropriate services.

The candidate will assess needs, implement and monitor plans, and participate in policy discussions. Requires an RN license and a BA/BS in a health field, with multi-state licensure as needed; hybrid/remote work options apply.

Qualifications

• BA/BS in a health-related field with 5 years of clinical experience or an equivalent background.
• Current, unrestricted RN license in home state; multi-state licensure if providing services in multiple states.
• Certification as a Case Manager is preferred.

Responsibilities

• Assess, develop, implement, coordinate, monitor, and evaluate care plans designed to optimize member health care across the care continuum.
• Perform duties telephonically to support members and providers.
• Ensure member access to services and coordinate internal and external resources.
• Interface with Medical Directors and Physician Advisors on care plans.
• Participate in utilization/care management policy development and cross-brand workgroups.

Skills

Care management

Education

BA/BS in health-related field

Job description

Anticipated End Date:
2026-09-22

Position Title:
Nurse Case Mgr Sr

Job Description

Location: This role enables associates to work virtually full-time, except for 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.

This position is not eligible for employment based sponsorship.

Hours: Monday- Friday 8:00am-4:30pm 1 evening -11:30am-8:00pm- biweekly (set night every two weeks)

The Nurse Case Mgr Sr 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. Performs 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.
• 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, chairs and schedules meetings, as well as presents cases for discussion at Grand Rounds/Care Conferences and participates in interdepartmental and/or cross brand workgroups.
• May require the development of a focused skill set including comprehensive knowledge of specific disease process or traumatic injury and functions as preceptor for new care management staff.
• Participates in department audit activities.

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 home state required.

Multi-state licensure is required if this individual is providing services in multiple states.

Preferred Skills, Capabilities and Experience:

Certification as a Case Manager is preferred

For candidates working in person or virtually in the below location, the salary* range for this specific position is $83,748 to $125,622

Location: 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 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 Exempt

Workshift:

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.

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