Remote Nurse Case Manager I (RN)

The Elevance Health Companies, Inc.; Boght Corners (NY); Remote; USD 71,000 - 106,000; Full time

Job summary

Elevance Health is seeking a Nurse Case Manager I (RN) for a virtual role with required in-person training sessions. The schedule is Monday–Friday, 9:00am–5:30pm (EST) with occasional late shifts, offering flexibility.

You will assess member needs, develop care plans, coordinate authorizations/referrals, and work with Medical Directors to ensure appropriate services. Requirements include a BA/BS in health-related field, active RN license, and multi-state licensure; Case Manager certification is

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 upon hire.
• Certification as a Case Manager is preferred.
• Previous case management experience.
• Home health experience, utilization management and/or hospital discharge planning experience is a plus.

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.
• Assists in problem solving with providers, claims or service issues.

Skills

Clinical experience

RN licensure

Multistate licensure

Case management knowledge

Education

BA/BS in health-related field

Job description

Elevance Health is seeking a Nurse Case Manager I (RN) for a virtual role with required in-person training sessions. The schedule is Monday–Friday, 9:00am–5:30pm (EST) with occasional late shifts, offering flexibility.

You will assess member needs, develop care plans, coordinate authorizations/referrals, and work with Medical Directors to ensure appropriate services. Requirements include a BA/BS in health-related field, active RN license, and multi-state licensure; Case Manager certification is