Remote Nurse Case Manager II

Elevance Health, Inc.; Norfolk (VA); Hybrid; USD 76,000 - 125,000; Full time

Job summary

Elevance Health, Inc. is seeking a Nurse Case Manager II to oversee care management for members with complex and chronic needs, using telephonic and on-site coordination to optimize health outcomes.

The role emphasizes assessment, plan development, and cross-functional collaboration to ensure appropriate service access and care continuity. The position requires a BA/BS in a health-related field and a minimum of 5 years of clinical experience, with an active RN license and multi-state licensure

Qualifications

• BA/BS in health field with 5+ years of clinical experience or equivalent
• Active RN license in applicable state(s); multi-state licensure required for multi-state service

Responsibilities

• Ensures member access to services appropriate to their health needs.
• Conducts assessments to identify needs and develop care management plans.
• Implements care plan by facilitating authorizations/referrals within benefits or extra-contractual arrangements.
• Coordinates internal and external resources to meet identified needs.
• Monitors and evaluates effectiveness of care management plans and makes modifications.
• Interacts with Medical Directors and Physician Advisors on care management plans.
• Negotiates reimbursement rates where applicable.
• Assists with problem solving with providers, claims or service issues.
• Contributes to development of utilization/care management policies and procedures.

Skills

Care coordination

Discharge planning

Telephonic case management

Clinical assessment

Education

Bachelor's degree in health-related field

Tools

RN licensure

Multistate licensure

Job description

Elevance Health, Inc. is seeking a Nurse Case Manager II to oversee care management for members with complex and chronic needs, using telephonic and on-site coordination to optimize health outcomes.

The role emphasizes assessment, plan development, and cross-functional collaboration to ensure appropriate service access and care continuity. The position requires a BA/BS in a health-related field and a minimum of 5 years of clinical experience, with an active RN license and multi-state licensure