Remote Telephonic Nurse Case Manager II

Elevance Health (Anthem); Boght Corners (NY); Remote; USD 76,000 - 119,000; Full time

Benefits offered by this job

comprehensive benefits package

incentive and recognition programs

equity stock purchase

401k contribution

Job summary

Elevance Health in the United States is hiring a Telephonic Nurse Case Manager II to coordinate care for members remotely, with in-person training sessions as required. This role supports work-life balance and autonomy while ensuring high-quality case management.

Candidates must have a BA/BS in a health-related field and RN licensure; multi-state licensure is required for cross-state service. The job includes coordinating authorizations, developing care plans, and collaborating with medical

Qualifications

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

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.
• 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

Microsoft Office

Education

BA/BS in health-related field

Tools

Microsoft Office

Job description

Elevance Health in the United States is hiring a Telephonic Nurse Case Manager II to coordinate care for members remotely, with in-person training sessions as required. This role supports work-life balance and autonomy while ensuring high-quality case management.

Candidates must have a BA/BS in a health-related field and RN licensure; multi-state licensure is required for cross-state service. The job includes coordinating authorizations, developing care plans, and collaborating with medical