Remote Nurse Case Manager II – Multistate Care Coordinator

Elevance Health; Atlanta (GA); Remote; USD 85,000 - 110,000; Full time

Job summary

Elevance Health is seeking a Nurse Case Manager II to manage care plans for members with complex health needs, coordinating assessments, authorizations, and referrals both telephonically and on-site as needed.

The role requires a BA/BS in a health-related field, at least 5 years of clinical experience, and current RN licensure. Multi-state licensure is required for serving members in multiple states, with hybrid/remote work options and required in-person training sessions.

Qualifications

• Requires BA/BS in a health-related field and minimum of 5 years of clinical experience; or any combination of education and experience, which would provide an equivalent background.
• Current, unrestricted RN license in applicable home state required.
• Multi-state licensure is required if this individual is 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 individual needs and a specific care management plan to address objectives and goals as identified during assessment.
• 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 the development of care management treatment 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

Clinical experience

Multi-state licensure

Education

BA/BS in health-related field

RN license

Job description

Elevance Health is seeking a Nurse Case Manager II to manage care plans for members with complex health needs, coordinating assessments, authorizations, and referrals both telephonically and on-site as needed.

The role requires a BA/BS in a health-related field, at least 5 years of clinical experience, and current RN licensure. Multi-state licensure is required for serving members in multiple states, with hybrid/remote work options and required in-person training sessions.