Remote Nurse Case Manager II – Care Coordination

Elevance Health; Louisville (KY); Remote; USD 65,000 - 90,000; Full time

Job summary

Elevance Health is seeking a Nurse Case Manager II to perform care management for members with complex and chronic needs, assessing, developing, implementing, coordinating, monitoring, and evaluating care plans across the care continuum. Duties may be conducted telephonically or on-site, including hospital discharge planning.

The role emphasizes member access to services, coordination of care, and collaboration with medical directors to optimize outcomes within a hybrid/virtual framework.

Qualifications

• BA/BS in a health-related field and minimum of 5 years of clinical experience.
• Current, unrestricted RN license in applicable state(s) required.
• Multi-state licensure is required if providing services in multiple states.

Responsibilities

• Assess and develop care management plans to optimize member health care.
• Coordinate care through authorizations/referrals within benefits or extra-contractual arrangements.
• Coordinate internal and external resources to meet identified needs.
• Monitor and evaluate care management plan effectiveness.
• Interface with Medical Directors and Physician Advisors on care plans.
• Negotiate rates of reimbursement when applicable.
• Assist with problem solving with providers, claims, or service issues.
• Contribute to development of utilization/care management policies and procedures.

Skills

Care management

Assessment

Coordination

Negotiation

Problem solving

Education

BA/BS in a health-related field

RN license

Multi-state licensure

Job description

Elevance Health is seeking a Nurse Case Manager II to perform care management for members with complex and chronic needs, assessing, developing, implementing, coordinating, monitoring, and evaluating care plans across the care continuum. Duties may be conducted telephonically or on-site, including hospital discharge planning.

The role emphasizes member access to services, coordination of care, and collaboration with medical directors to optimize outcomes within a hybrid/virtual framework.