Pediatric Nurse Case Mgr I

Elevance Health (Anthem); Florida; Hybrid; USD 65,000 - 80,000; Full time

Job summary

Elevance Health in Orlando is seeking a Pediatric Nurse Case Manager I to perform care management for members with complex needs, both telephonically and on-site. The role is field-based with occasional office attendance, requiring travel to member sites within Orlando, FL.

The position emphasizes assessing, developing, implementing, coordinating and monitoring care plans to optimize health outcomes. A valid Florida RN license is required, with a BA/BS in a health-related field and at least 3

Qualifications

• Requires BA/BS in a health-related field and minimum of 3 years of pediatric clinical experience.
• Current, unrestricted RN license in the state of Florida is required.
• Bilingual communication skills in Spanish and English strongly preferred; Certification as a Case Manager preferred; Computer savvy.

Responsibilities

• Ensures member access to services appropriate to health needs.
• Conducts assessments to identify individual needs and a care management plan to address objectives and goals.
• Implements care plan by facilitating authorizations/referrals 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 care management plans.
• Negotiates rates of reimbursement, as applicable.
• Assists in problem solving with providers, claims or service issues.

Skills

Pediatric clinical experience

RN license

Bilingual (Spanish/English)

Case management

Education

BA/BS in health-related field

Tools

Electronic health records

Job description

Job Overview

Anticipated End Date: 2026-09-26

Position Title: Pediatric Nurse Case Mgr I

Job Description: Pediatric Nurse Case Mgr I - Orlando, Florida

• This Field Based position will be required to visit members in person within Orlando, FL .

Location: Field Based - This field-based role enables associates to primarily operate in the field, traveling to client sites or designated locations as their role requires, with occasional office attendance for meetings or training. This approach ensures flexibility, responsiveness to client needs, and direct, hands-on engagement. 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 accommodation is granted as required by law.

Work Shift: Monday - Friday: 8:00 am to 5:00 pm (EST)

The Pediatric Nurse Case Mgr I 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 will you 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.

Minimum Requirements

• Requires BA/BS in a health related field and minimum of 3 years of pediatric clinical experience ; or any combination of education and experience, which would provide an equivalent background.
• Current, unrestricted RN license in the state of Florida is required .

Preferred Skills, Capabilities and Experiences

• Bilingual communication skills in Spanish and English strongly preferred.
• Certification as a Case Manager preferred.
• Computer savvy.

Job Level: Non-Management Exempt

Workshift: 1st Shift (United States of America)

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.

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