Registered Nurse (RN) Manger/Case Manager

Elevance Health; Virginia; Hybrid; USD 85,000 - 110,000; Full time

Job summary

Elevance Health is hiring a Telephonic Nurse Case Manager II to coordinate care for members with complex and chronic needs. The role involves assessing needs, developing and implementing care plans, coordinating authorizations and referrals, and monitoring outcomes to improve health across the care continuum.

The position requires an active RN license, a BA/BS in a health-related field, and Case Management certification, with at least two years in acute care.

Qualifications

• BA/BS in health-related field is required.
• Current, unrestricted RN license in applicable state required.
• Case Management experience is required.
• Certification as a Case Manager is required.
• Minimum 2 years’ experience in acute care setting.
• Experience with Microsoft Office and ability to learn new software quickly.
• Ability to manage, review and respond to emails/instant messages promptly.

Responsibilities

• Conduct care management for members with complex and chronic needs by assessing, developing, implementing, coordinating, monitoring, and evaluating care plans to optimize health care across the continuum.
• Identify individual needs and create a care management plan during assessment.
• Facilitate authorizations/referrals within benefits structure or extra-contractual arrangements as needed.
• Monitor and adjust care plans based on effectiveness.
• Collaborate with Medical Directors and Physician Advisors on treatment plans.
• Negotiate reimbursement rates where applicable.
• Assist with problem solving regarding providers, claims, or service issues.
• Assist in development of utilization/care management policies and procedures.

Skills

Case management

Email/communication

Education

BA/BS in health-related field

RN license

Tools

Microsoft Office

Job description

Telephonic Nurse Case Manager II Job Description

Telephonic Nurse Case Manager II

Location: 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.

Hours: Monday - Friday 9am to 5:30pm with 2-4 evenings per month 11:30am to 8:00pm.

Key Responsibilities

• *****The Telephonic 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. 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.
• 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.

Required Qualifications

• Requires BA/BS in a health-related field and minimum of 5 years of clinical experience; Current, unrestricted RN license in applicable state required.
• Case 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.

Benefits and Compensation

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 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. 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.

Non-Management Exempt Workshift

Licensed Nurse

Company Overview

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.

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. 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.

Compensation and Benefits Details

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.

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.

Vaccination Policy

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. Elevance Health will also follow all relevant federal, state and local laws.

Equal Employment Opportunity

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 following form: 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.

Florida Screening

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

Posting Notice

NOTE: Workday keeps job postings active through 11:59:59 PM on the day before the listed end date.