Nurse Case Manager I

Nurse Case Manager I

The ideal candidate would reside within the state of Texas.

This field-based role enables associates to primarily operate in the field, traveling to client sites or designated locations as their role requires, with occasional office attendance for meetings or training. This approach ensures flexibility, responsiveness to client needs, and direct, hands-on engagement.

Carelon, a proud member of the Elevance Health family of companies, is a healthcare services organization that takes a whole-health approach to making care more integrated, personalized, and affordable. We put people at the centerconnecting physical, behavioral, social, and pharmacy services, along with clinical expertise, research, operations, and advanced technology to help care work better, together.

Among us are specialty-care physicians, nurse practitioners, pharmacists, engineers, data scientists, and other dedicated and caring health professionals. While our roles may differ, our purpose is shared: to make a positive impact on whole health.

The Nurse Case Manager I will be responsible for performing care management within the scope of licensure for members with complex and chronic care needs by assessing, developing, implementing, coordinating, monitoring, and evaluating care plans designed to optimize member health care across the care continuum. Performs duties telephonically or on-site such as at hospitals, member's home, or clinics for assistance with decreasing hospital/ER readmission. The Nurse Case Manager will be in the field 2x-3x a week based on business needs.

How you will make an impact:

• 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 referrals as appropriate within benefits structure or through state 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.
• Assists in problem solving with providers, claims or service issues.

Minimum Requirements:

• Requires BA/BS in a health-related field and minimum of 3 years of clinical experience; or any combination of education and experience, which would provide an equivalent background.
• Current, unrestricted RN license within the state of Texas is required.
• Multi-state licensure is required if this individual is providing services in multiple states.

Preferred Skills, Capabilities and Experiences:

• Certification as a Case Manager is preferred.
• Experience with Microsoft TEAMs, Outlook, Word, and Excel.
• Experience with Home Health completing field visits.
• Experience with Medicaid.
• Positive, strong interpersonal and communication skills.

Job Level: Non-Management Exempt