Nurse Case Manager II (US)

Position Title Nurse Case Manager II (US) Location & Work Arrangement Telephonic; works virtually full‑time with required in‑person training sessions. Must reside in Kentucky. Hours Monday - Friday, 8:30‑5:00 or 9:30‑6:00pm EST. Responsibilities Provide care management within scope of licensure for members with complex and chronic care needs. Conduct assessments to identify individual needs and develop targeted care plans. Implement care plans by facilitating authorizations and referrals within benefits structure or through external arrangements. Coordinate internal and external resources to meet identified needs. Monitor and evaluate effectiveness of care plans, modifying as necessary. Interface with Medical Directors and Physician Advisors on treatment plans. Negotiate reimbursement rates where applicable and assist with provider, claims, or service issue resolution. Contribute to the development of utilization and care management policies and procedures. Minimum Requirements BA/BS in a health‑related field or equivalent combination of education and experience (minimum 5 years of clinical experience). Current, unrestricted RN license in Kentucky (multi‑state licensure required if services are provided in additional states). Preferred Skills, Capabilities, and Experiences Certification as a Case Manager. BS in a health or human services related field. Kentucky RN license. Equal Employment Opportunity Elevance Health is an Equal Employment Opportunity Employer; 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 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. #J-18808-Ljbffr The Elevance Health Companies, Inc.