Remote Nurse Case Manager II — Complex Care Navigator

Elevance Health; Louisville (KY); Remote; USD 65,000 - 90,000; Full time

Job summary

Elevance Health is seeking a Nurse Case Manager II to support members with complex health needs. The role is virtual full-time with in-person training and occasional office visits required for onboarding.

Candidates must have multi-state licensure and an active RN license, with experience in case and utilization management. The position involves coordinating care plans, authorizations, and collaborating with medical directors across multiple states including IL, KY, MO, VA, WI, and OH.

Qualifications

• Current, unrestricted RN license in applicable state.
• Multi-state licensure required if servicing multiple states.
• 2+ years of acute care experience.
• Case management and utilization management experience.
• Certification as a Case Manager preferred.
• Proficiency with Microsoft Office and quick learning of new systems.

Responsibilities

• Ensure member access to services appropriate to health needs.
• Conduct assessments to identify needs and develop care plans.
• Implement care plan with authorizations/referrals within benefits or extra-contractual arrangements.
• Coordinate internal and external resources to meet needs.
• Monitor and evaluate care management plans and adjust as needed.
• Interface with Medical Directors and Physician Advisors on treatment plans.
• Negotiate reimbursement rates as applicable.
• Assist with problem solving with providers, claims or service issues.
• Assist with development of utilization/care management policies and procedures.

Skills

Case Management

Utilization Management

Case Manager Certification

Acute care experience

MS Office

Email management

Education

RN licensed

Multi-state licensure

Job description

Elevance Health is seeking a Nurse Case Manager II to support members with complex health needs. The role is virtual full-time with in-person training and occasional office visits required for onboarding.

Candidates must have multi-state licensure and an active RN license, with experience in case and utilization management. The position involves coordinating care plans, authorizations, and collaborating with medical directors across multiple states including IL, KY, MO, VA, WI, and OH.