Remote Nurse Case Manager I — Care Coordination

elevancehealth; St. Louis (MO); Hybrid; USD 60,000 - 85,000; Full time

Job summary

Elevance Health is seeking a Nurse Case Manager I to perform care management for members with complex needs, assessing and coordinating care plans. Role may be telephonic or on-site for discharge planning and requires BA/BS in a health field and an active RN license.

The position supports a hybrid/remote work arrangement with occasional in-person training, and requires multi-state licensure if services are in multiple states.

Qualifications

• Requires BA/BS in a health related field and minimum of 3 years of clinical experience.
• Current, unrestricted RN license in applicable state(s) required.
• Multi-state licensure is required if providing services in multiple states.
• Certification as a Case Manager is preferred.

Responsibilities

• Performs care management within licensure scope for members with complex needs.
• Assesses, develops, implements, coordinates, monitors and evaluates care plans.
• Facilitates authorizations/referrals within benefits or extra-contractual arrangements.
• Coordinates internal and external resources to meet identified needs.
• Monitors and evaluates care management plan effectiveness and adjusts as needed.
• Interfaces with Medical Directors/Physician Advisors on care plans.
• Negotiates rates of reimbursement where applicable.
• Assists in problem solving with providers, claims or service issues.

Skills

Clinical experience

RN license

Multistate licensure

Case management certification

Education

BA/BS in health-related field

Job description

Elevance Health is seeking a Nurse Case Manager I to perform care management for members with complex needs, assessing and coordinating care plans. Role may be telephonic or on-site for discharge planning and requires BA/BS in a health field and an active RN license.

The position supports a hybrid/remote work arrangement with occasional in-person training, and requires multi-state licensure if services are in multiple states.