Remote Nurse Case Manager II | Care Coordination Pro

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

Job summary

Elevance Health is seeking a Nurse Case Manager II to manage complex patient care plans, coordinating services and authorizations across the care continuum. The role supports telephonic and on-site activities, including discharge planning, with a strong emphasis on driving optimal outcomes for members.

Requires an RN license and BA/BS in a health-related field, with at least 5 years of clinical experience. Hybrid/virtual work model with in-person training sessions is offered.

Qualifications

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

Responsibilities

• Assess, develop, implement, coordinate, monitor, and evaluate care plans for members with complex/ chronic care needs.
• Perform discharge planning and other duties telephonically or on-site.
• Coordinate internal and external resources to meet identified needs.
• Facilitate authorizations/referrals within benefits structure or through extra-contractual arrangements.
• Monitor and evaluate effectiveness of the care management plan and modify as needed.
• Interface with Medical Directors and Physician Advisors on care management plans.
• Negotiate rates of reimbursement as applicable.
• Assist with problem solving with providers, claims, or service issues.

Skills

RN license

Care management

Telephonic communication

Education

BA/BS in health-related field

Job description

Elevance Health is seeking a Nurse Case Manager II to manage complex patient care plans, coordinating services and authorizations across the care continuum. The role supports telephonic and on-site activities, including discharge planning, with a strong emphasis on driving optimal outcomes for members.

Requires an RN license and BA/BS in a health-related field, with at least 5 years of clinical experience. Hybrid/virtual work model with in-person training sessions is offered.