Nurse Case Manager I

Care Management Specialist

Locations: Lake Mary FL, Tampa FL, Miami FL, Indianapolis IN, Grand Prairie TX, Mason OH, Richmond VA, Atlanta GA, Manchester NH, Waukesha WI, Durham NC, St Louis MO, Louisville KY

Hours: Standard working hours (Monday-Friday)

Travel: 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. Please note that 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.

Position Overview:

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 for discharge planning.

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

Required Qualifications:

• 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 in applicable state(s) required. Multi-state licensure is required if this individual is providing services in multiple states.
• For URAC accredited areas the following applies: Requires BA/BS and 3 years of clinical care experience; or any combination of education and experience, which would provide an equivalent background.

Preferred Qualifications:

• Certification as a Case Manager is preferred.
• Previous experience with utilization review and/or prior authorization.
• Clinical case management experience in an inpatient or outpatient setting.
• Demonstrates critical thinking skills when interacting with members.
• 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.
• Excellent collaboration, communication and teamwork skills.

For candidates working in person or virtually in the below location(s), the salary* range for this specific position is $63,840 to $100,800

Locations: Virginia

In addition to your salary, Elevance Health offers benefits such as a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). The salary offered for this specific position is based on a number of legitimate, non-discriminatory factors set by the Company. The Company is fully committed to ensuring equal pay opportunities for equal work regardless of gender, race, or any other category protected by federal, state, and local pay equity laws.

*The salary range is the range Elevance Health in good faith believes is the range of possible compensation for this role at the time of this posting. This range may be modified in the future and actual compensation may vary from posting based on geographic location, work experience, education and/or skill level. Even within the range, the actual compensation will vary depending on the above factors as well as market/business considerations. No amount is considered to be wages or compensation until such amount is earned, vested, and determinable under the terms and conditions of the applicable policies and plans. The amount and availability of any bonus, commission, benefits, paid time off, stock, or any other form of compensation and benefits that are allocable to a particular employee remains in the Company's sole discretion unless and until paid and may be modified at the Company's sole discretion, consistent with the law.