Nurse Case Manager I

Nurse Case Manager I Location: Cincinnati, Columbus, Mason and Seven Hills, OH offices and surrounding areas. Field-based role with some virtual work. Field: Associates will primarily operate in the field, traveling to client sites or designated locations as required, with occasional office attendance for meetings or training. Shift: Monday – Friday, 8:30 am – 5:00 pm EST. No weekends or holidays required. Responsibilities Ensure member access to services appropriate to their health needs. Conduct assessments to identify individual needs and develop a specific care management plan. Implement care plans by facilitating authorizations/referrals as appropriate within the benefits structure or through extra‑contractual arrangements. Coordinate internal and external resources to meet identified needs. Monitor and evaluate the effectiveness of the care management plan and modify as necessary. Interface with Medical Directors and Physician Advisors on the development of care management treatment plans. Negotiate rates of reimbursement, as applicable. Assist in problem‑solving with providers, claims or service issues. Minimum Requirements BA/BS in a health‑related field and a minimum of 3 years of clinical experience; or an equivalent combination of education and experience. Current, unrestricted RN license in applicable state(s). Multi‑state licensure if serving in multiple states. For URAC accredited areas, BA/BS and 3 years of clinical care experience or equivalent. Preferred Skills, Capabilities and Experiences Certification as a Case Manager and a BS in a health or human services related field. Previous OB/NICU experience. Salary Range: $67,000 – $84,000. Equal Employment Opportunity Elevance Health is an Equal Employment Opportunity employer and all qualified applicants will receive consideration for employment without regard to age, citizenship status, color, creed, disability, ethnicity, genetic information, gender (including gender identity and gender expression), marital status, national origin, race, religion, sex, sexual orientation, veteran status or any other status or condition protected by applicable federal, state or local laws. Applicants who require accommodation to participate in the job application process may contact View email address on click.appcast.io for assistance. #J-18808-Ljbffr