Remote Nurse Case Manager I — Care Coordination

Elevance Health; Indianapolis (IN); Hybrid; USD 55,000 - 83,000; Full time

Job summary

Elevance Health is seeking a contract-based Care Manager to support member care in a hybrid work model. The role requires an RN license, a BA/BS, and case management certification, with multi-state licensure preferred, and 3+ years of clinical care experience.

The incumbent will assess needs, develop care plans, coordinate authorizations and referrals, collaborate with medical directors, and monitor plan effectiveness while navigating reimbursement discussions.

Qualifications

• BA/BS and 3 years of clinical care experience; or equivalent background.
• Current and active RN license in applicable state(s).
• Multi-state licensure is required if providing services in multiple states.
• Certification as a Case Manager and BS in health/human services preferred.

Responsibilities

• Ensures member access to services appropriate to health needs.
• Conducts assessments and develops care management plans.
• Implements care plans via authorizations/referrals within benefits or through arrangements.
• Coordinates internal and external resources to meet needs.
• Monitors and evaluates plan effectiveness and updates as necessary.
• Interfaces with Medical Directors and Physician Advisors on treatment plans.
• Negotiates rates of reimbursement when applicable.
• Assists in problem solving with providers, claims or service issues.

Skills

RN license

Case management

Clinical care experience

Education

BA/BS in health or human services

RN licensure (licensure)

Job description

Elevance Health is seeking a contract-based Care Manager to support member care in a hybrid work model. The role requires an RN license, a BA/BS, and case management certification, with multi-state licensure preferred, and 3+ years of clinical care experience.

The incumbent will assess needs, develop care plans, coordinate authorizations and referrals, collaborate with medical directors, and monitor plan effectiveness while navigating reimbursement discussions.