Remote Nurse Case Manager I - Care Coordination

Elevance Health; Indianapolis (IN); Hybrid; USD 60,000 - 78,000; Full time

Job summary

Elevance Health is seeking a Nurse Case Manager I to manage care for members with complex and chronic needs, coordinating assessments, plans, and discharge planning either telephonically or on-site. The role supports a hybrid work model with essential in-person training.

Minimum qualifications include a BA/BS in a health-related field with 3 years of clinical experience and an active RN license; multi-state licensure may be required for service coverage across states.

Qualifications

• Requires BA/BS in a health related field and minimum of 3 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.
• For URAC accredited areas the following applies: Requires BA/BS and 3 years of clinical care experience; or any combination of education and experience, which would provide an equivalent background. Current and active RN license required in applicable state(s). Multi-state licensure is required if this individual is providing services in multiple states.
• Preferred: Certification as a Case Manager; Experience with home health or Med-Surg; Bilingual is strongly preferred.

Responsibilities

• 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.

Skills

RN license

Bachelors in health-related field

Multi-state licensure

Case management experience

Job description

Elevance Health is seeking a Nurse Case Manager I to manage care for members with complex and chronic needs, coordinating assessments, plans, and discharge planning either telephonically or on-site. The role supports a hybrid work model with essential in-person training.

Minimum qualifications include a BA/BS in a health-related field with 3 years of clinical experience and an active RN license; multi-state licensure may be required for service coverage across states.