Nurse Case Manager II (US)

Telephonic Nurse Case Manager II Location: Virtual full‑time with occasional on‑site training; Must reside in Kentucky. Hours: Monday – Friday, 8:30‑5 or 9:30‑6 pm EST. Job Overview: The Telephonic Nurse Case Manager II is responsible for care management within the scope of licensure for members with complex and chronic care needs. Duties include assessing, developing, implementing, coordinating, monitoring, and evaluating care plans designed to optimize member health care across the continuum. Services are delivered telephonically or on‑site, such as at hospitals for discharge planning. Responsibilities Ensures member access to services appropriate to their health needs. Conducts assessments to identify individual needs and develops specific care management plans to address identified objectives and goals. Implements care plans 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. Minimum Requirements BA/BS in a health‑related field and a minimum of 5 years of clinical experience; or an equivalent combination of education and experience. Current, unrestricted RN license in the applicable state(s) required. Multi‑state licensure is required if services are provided in multiple states. Preferred Skills, Capabilities, and Experiences Certification as a case manager preferred. BS in a health or human services related field preferred. Kentucky RN license. Benefits We offer a range of market‑competitive total rewards that include merit increases, paid holidays, paid time off, incentive bonus programs, medical, dental, vision, short‑ and long‑term disability benefits, 401(k) with match, stock purchase plan, life insurance, wellness programs, and financial education resources. Equal Employment Opportunity Statement 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, and local laws. Applicants who require accommodation to participate in the job application process may contact View email address on click.appcast.io for assistance. Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state, and local laws, including, but not limited to, the Los Angeles County Fair Chance Ordinance and the California Fair Chance Act. #J-18808-Ljbffr Elevance Health