Remote Nurse Case Manager II - Care Coordination Expert

Elevance Health, Inc.; Los Angeles (CA); Remote; USD 83,000 - 136,000; Full time

Job summary

Elevance Health is seeking a Nurse Case Manager II to oversee care management for members with complex and chronic needs, assessing health requirements and coordinating plans to optimize outcomes. Duties may be telephonic or on-site, including hospital discharge planning.

The role emphasizes collaboration with medical directors, referrals, and utilization review, with a focus on member access to appropriate services. Remote work is available with in-person onboarding as needed.

Qualifications

• Requires BA/BS in a health-related field and minimum of 5 years of clinical experience; RN license required.
• Multi-state licensure is required if providing services in multiple states.
• Certification as a Case Manager is preferred.

Responsibilities

• Ensures member access to services appropriate to their health needs.
• Conducts assessments to identify needs and develop a care management plan.
• Implements care plan by facilitating authorizations/referrals within benefits structure or via 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 care management plans.
• Negotiates 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

Care management

Discharge planning

Interdisciplinary collaboration

Assessment skills

Education

BA/BS in health-related field

RN license (unrestricted)

Multi-state licensure

Job description

Elevance Health is seeking a Nurse Case Manager II to oversee care management for members with complex and chronic needs, assessing health requirements and coordinating plans to optimize outcomes. Duties may be telephonic or on-site, including hospital discharge planning.

The role emphasizes collaboration with medical directors, referrals, and utilization review, with a focus on member access to appropriate services. Remote work is available with in-person onboarding as needed.