Remote Nurse Case Manager I — Care Coordination

Elevance Health; St. Louis (MO); Hybrid; USD 70,000 - 90,000; Full time

Job summary

Elevance Health seeks a Nurse Case Manager I to perform care management for members with complex needs, coordinating assessments, plans, and authorizations. The role can be telephonic or on-site, with occasional in-person training.

You will collaborate with Medical Directors, coordinate resources, monitor outcomes, and ensure appropriate access to services. Required RN license, BA/BS in health field, and 3 years of clinical experience; multi-state licensure preferred.

Qualifications

• BA/BS in health field with 3+ years of clinical experience, or equivalent combination.
• Current, unrestricted RN license in applicable state(s) required.
• Multi-state licensure required if providing services in multiple states.

Responsibilities

• Ensures member access to services appropriate to their health needs.
• Conducts assessments to identify needs and develop care plans.
• Implements care plans by facilitating authorizations/referrals.
• Coordinates internal and external resources.
• Monitors and evaluates care plan effectiveness.
• Interfaces with Medical Directors and Physician Advisors on care plans.
• Negotiates rates of reimbursement, as applicable.
• Assists in problem solving with providers, claims or service issues.

Skills

RN license

Multistate licensure

Clinical experience

Education

BA/BS in health-related field

Job description

Elevance Health seeks a Nurse Case Manager I to perform care management for members with complex needs, coordinating assessments, plans, and authorizations. The role can be telephonic or on-site, with occasional in-person training.

You will collaborate with Medical Directors, coordinate resources, monitor outcomes, and ensure appropriate access to services. Required RN license, BA/BS in health field, and 3 years of clinical experience; multi-state licensure preferred.