Remote Nurse Case Manager I: Care Coordinator

Elevance Health; Saint Louis (CA); Hybrid; USD 65,000 - 90,000; Full time

Job summary

Elevance Health is seeking a Nurse Case Manager I to perform care management for members with complex needs, assessing, developing, implementing, and coordinating care plans across the continuum. Duties include telephonic and on-site discharge planning as needed.

The role supports flexible, hybrid/virtual work arrangements with required in-person training, and requires RN licensure with multi-state eligibility.

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.
• Certification as a Case Manager and a BS in a health or human services related field 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

Clinical nursing

Care management

Discharge planning

Education

BA/BS in health-related field

RN license

Multi-state licensure

Job description

Elevance Health is seeking a Nurse Case Manager I to perform care management for members with complex needs, assessing, developing, implementing, and coordinating care plans across the continuum. Duties include telephonic and on-site discharge planning as needed.

The role supports flexible, hybrid/virtual work arrangements with required in-person training, and requires RN licensure with multi-state eligibility.