Telephonic Nurse Case Manager II

Location This role enables associates to work virtually full-time, with the exception of required in‑person training sessions, providing maximum flexibility and autonomy. This approach promotes productivity, supports work‑life integration, and ensures essential face‑to‑face onboarding and skill development. Alternate locations may be considered if candidates reside within a commuting distance from an office. Per our policy on hybrid/virtual work, candidates not within a reasonable commuting distance from the posting location(s) will not be considered for employment, unless an accommodation is granted as required by law. Hours Monday – Friday 8:00 am to 4:30 pm EST and some evenings 11:30 am to 8:00 pm EST. Position 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 by assessing, developing, implementing, coordinating, monitoring, and evaluating care plans designed to optimize member health care across the care continuum. Performs duties telephonically. 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 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 minimum of 5 years of clinical experience; or any combination of education and experience which would provide an equivalent background. Current, unrestricted RN license in applicable state required. Multi‑state licensure is required if this individual is providing services in multiple states. Preferred Capabilities, Skills and Experiences Case Management experience. Certification as a Case Manager. Minimum 2 years’ experience in acute care setting. Experience with Microsoft Office and/or ability to learn new computer programs/systems/software quickly. Ability to manage, review and respond to emails/instant messages in a timely fashion. Salary Range The salary range for this position is $75,680 to $119,196. Salary is based on geographic location, work experience, education and skill level. Benefits Other benefits include a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contributions (subject to eligibility). EEO 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, or local laws. Qualified applicants with arrest or conviction records will be considered in accordance with all federal, state, and local laws. #J-18808-Ljbffr Elevance Health