Remote Telephonic Nurse Case Manager II

Elevance Health; Virginia Beach (VA); Hybrid; USD 76,000 - 119,000; Full time

Job summary

Elevance Health is seeking a Telephonic Nurse Case Manager II who will work virtually with occasional in-person training. The role requires an active RN license and multi-state licensure for service across states, including New York and Virginia.

The position offers a hybrid work model with required in-person onboarding and scheduled hours. The role involves assessing member needs, developing care plans, coordinating resources, and ensuring appropriate service access.

Qualifications

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

Responsibilities

• Ensures member access to services appropriate to health needs.
• Conducts assessments to identify needs and creates a care management plan.
• Implements care plan by facilitating authorizations/referrals within benefits or through extra-contractual arrangements.
• Coordinates internal and external resources to meet identified needs.
• Monitors and evaluates the effectiveness of the care management plan and modifies as needed.
• Interacts with Medical Directors and Physician Advisors on care plans.
• Negotiates reimbursement rates as applicable.
• Assists in solving issues with providers, claims, or services.
• Contributes to development of utilization/care management policies and procedures.

Skills

Case management experience

Case Manager certification

Microsoft Office

Multi-state licensure

Education

BA/BS in health-related field

Job description

Elevance Health is seeking a Telephonic Nurse Case Manager II who will work virtually with occasional in-person training. The role requires an active RN license and multi-state licensure for service across states, including New York and Virginia.

The position offers a hybrid work model with required in-person onboarding and scheduled hours. The role involves assessing member needs, developing care plans, coordinating resources, and ensuring appropriate service access.