Remote Nurse Case Manager II - Complex Care Navigator

Elevance Health; Latham (NY); Hybrid; USD 76,000 - 119,000; Full time

Benefits offered by this job

Medical benefits

Dental benefits

Vision benefits

401(k) plan

Stock purchase plan

Wellness programs

Job summary

Elevance Health is seeking a Nurse Case Manager II to supervise care management for members with complex and chronic conditions. The role is telephonic with required in-person training, offering flexibility within a hybrid work model.

The position involves assessing needs, developing and coordinating care plans, and authorizing services while collaborating with medical directors to optimize outcomes. Requires RN licensure and 5+ years of clinical experience; multi-state licensure is preferred.

Qualifications

• Requires BA/BS in a health-related field and minimum of 5 years of clinical experience.
• Current, unrestricted RN license in applicable state(s).
• Multi-state licensure required if providing services in multiple states.
• Case management certification preferred; compact license preferred.
• Must reside in EST/CST zones.

Responsibilities

• Ensures member access to services appropriate to their health needs.
• Conducts assessments to identify needs and a care management plan to address objectives.
• Implements care plan by facilitating authorizations/referrals within benefits or through extras.
• 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

RN licensure

Case management

Multi-state licensure

EST/CST residency

Education

BA/BS in health-related field

RN license education

Job description

Elevance Health is seeking a Nurse Case Manager II to supervise care management for members with complex and chronic conditions. The role is telephonic with required in-person training, offering flexibility within a hybrid work model.

The position involves assessing needs, developing and coordinating care plans, and authorizing services while collaborating with medical directors to optimize outcomes. Requires RN licensure and 5+ years of clinical experience; multi-state licensure is preferred.