Remote Nurse Case Manager II — Care Coordination Lead

Elevance Health; Tampa (FL); Hybrid; USD 79,000 - 119,000; Full time

Job summary

Elevance Health is seeking a Nurse Case Manager II to manage complex care needs. Responsibilities include assessing, developing, implementing, coordinating, monitoring and evaluating care plans across the care continuum, with telephonic or on-site discharge planning.

The role supports a hybrid/virtual work model with required in-person trainings. Requires BA/BS in health-related field, current RN license, and at least five years of clinical experience; multistate licensure may be needed.

Qualifications

• BA/BS in a health-related field is required.
• Current, unrestricted RN license in applicable state(s).
• Multi-state licensure is required if providing services in multiple states.
• Certification as a Case Manager is preferred.

Responsibilities

• Assess member needs and develop care management plans.
• Coordinate and monitor care across the continuum, including discharge planning.
• Facilitate authorizations/referrals within benefits or through extra-contractual arrangements.
• Interface with Medical Directors and Physician Advisors on care plans.
• Monitor effectiveness and modify care plans as needed.
• Negotiate rates of reimbursement when applicable.
• Assist with problem solving with providers, claims or service issues.
• Contribute to utilization/care management policies and procedures.

Skills

RN license

Multi-state licensure

Clinical experience

Education

BA/BS in health-related field

Job description

Elevance Health is seeking a Nurse Case Manager II to manage complex care needs. Responsibilities include assessing, developing, implementing, coordinating, monitoring and evaluating care plans across the care continuum, with telephonic or on-site discharge planning.

The role supports a hybrid/virtual work model with required in-person trainings. Requires BA/BS in health-related field, current RN license, and at least five years of clinical experience; multistate licensure may be needed.