Nurse Case Mgr SR

Job Overview Anticipated End Date: 2026-06-01 Position Title: Nurse Case Manager – Senior Location: District of Columbia (Washington, DC) and Maryland. Requires in‑office presence four days per week with flexibility for virtual work within reasonable commuting distance. Key Responsibilities Ensures member access to services appropriate to their health needs. Conducts assessments to identify individual needs and develops a care management plan to address objectives and goals. Implements the care plan by facilitating authorizations/referrals within benefit structures 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; chairs and schedules meetings; presents cases for discussion at Grand Rounds/Care Conferences. Participates in interdepartmental and/or cross‑brand workgroups. May develop a focused skill set for specific disease processes or traumatic injury and serve as preceptor for new care management staff. Participates in department audit activities. Minimum Qualifications Bachelor’s degree in a health‑related field and at least five years of clinical experience, or an equivalent combination of education and experience. Current, unrestricted RN license in the applicable State of Residence. Preferred Skills & Experience Certification as a Case Manager (preferred). Active, unrestricted DC RN licensure (highly preferred). Salary & Benefits Salary range: $83,748 – $137,586 (based on location, experience, and qualifications). Benefits include a comprehensive package, equity stock purchase plan, 401(k) contribution with match, and other standard benefits as per company policy. Equal Employment Opportunity Elevance Health is an Equal Employment Opportunity employer; all qualified applicants will receive consideration for employment without regard to age, citizenship, color, creed, disability, ethnicity, gender identity, marital status, national origin, race, religion, sex, sexual orientation, veteran status, or any other protected characteristic. #J-18808-Ljbffr