Remote Nurse Case Manager II - Care Coordination Expert

Elevance Health; Latham (NY); Hybrid; USD 76,000 - 125,000; Full time

Benefits offered by this job

Benefits package

Equity stock purchase

401(k) plan

Job summary

Elevance Health in New York is seeking a Nurse Case Manager II to manage complex and chronic care needs for members, assessing, developing, implementing, coordinating, monitoring, and evaluating care plans. Duties are performed telephonically with some in-person training sessions and multi-state licensure requirements.

This role supports a flexible, hybrid work model with in‑person onboarding, cross‑state care coordination, and collaboration with Medical Directors to optimize member health

Qualifications

• Current, unrestricted RN license in applicable state.
• Multi-state licensure is required if this individual provides services in multiple states.
• Case Management experience.
• Utilization Management experience.
• Certification as a Case Manager.
• Minimum 2 years’ experience in acute care setting.
• Experience with (Microsoft Office) and/or ability to learn new computer programs/systems/software quickly.

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.
• Implement 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.
• Negotiate rates of reimbursement, as applicable.
• Assists in problem solving with providers, claims or service issues.
• Assists with development of utilization/care management policies and procedures.

Skills

RN license

Multi-state licensure

Case management

Utilization management

Case manager certification

Acute care experience

Microsoft Office

Tools

Microsoft Office

Job description

Elevance Health in New York is seeking a Nurse Case Manager II to manage complex and chronic care needs for members, assessing, developing, implementing, coordinating, monitoring, and evaluating care plans. Duties are performed telephonically with some in-person training sessions and multi-state licensure requirements.

This role supports a flexible, hybrid work model with in‑person onboarding, cross‑state care coordination, and collaboration with Medical Directors to optimize member health