Remote Nurse Case Manager II (Multistate Licensure)

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

Benefits offered by this job

Benefits package

Hybrid work model

Job summary

Elevance Health is seeking a Telephonic Nurse Case Manager II to provide comprehensive care management for members with complex, chronic conditions across states. The role is largely telephonic with required in-person trainings and occasional travel.

Multi-state licensure is required. The position emphasizes assessment, care planning, and coordination of internal and external resources to optimize healthcare delivery.

Qualifications

• Requires BA/BS in a health-related field and minimum of 5 years of clinical experience.
• Current, unrestricted RN license in applicable state required.
• Multi-state licensure is required if this individual is providing services in multiple states.

Responsibilities

• Ensures member access to services appropriate to their health needs.
• Conducts assessments to identify individual needs and develops a specific care management plan to address objectives.
• Implements care plan by facilitating authorizations/referrals as appropriate within benefits structure or through extra-contractual arrangements.
• 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

Case management

RN license

Multi-state licensure

Communication

Education

BA/BS in health-related field

Tools

Microsoft Office

Job description

Elevance Health is seeking a Telephonic Nurse Case Manager II to provide comprehensive care management for members with complex, chronic conditions across states. The role is largely telephonic with required in-person trainings and occasional travel.

Multi-state licensure is required. The position emphasizes assessment, care planning, and coordination of internal and external resources to optimize healthcare delivery.