Nurse Case Manager I

Nurse Case Manager I Location: Cincinnati, Columbus, Mason, and Seven Hills, OH offices and surrounding areas. Field‑based role with some virtual work; requires a reasonable commuting distance to one of the sites. Shift: Monday – Friday, 8:30am – 5:00pm EST; no weekend or holiday coverage required. Responsibilities Perform care management within licensure for members with complex and chronic care needs by assessing, developing, implementing, coordinating, monitoring, and evaluating care plans to optimize member health across the care continuum. Conduct assessments to identify individual needs and create specific care management plans with identified goals. Implement care plans by facilitating authorizations/referrals, coordinating internal and external resources, and ensuring appropriate service access. Monitor and evaluate effectiveness of care plans, modifying as necessary. Interface with Medical Directors and Physician Advisors on treatment plans and negotiate reimbursement rates. Assist in problem‑solving with providers, claims, or service issues, and perform discharge planning duties telephonically or on‑site at hospitals. Minimum Requirements BA/BS in a health‑related field (or equivalent education/experience). Current, unrestricted RN license in the applicable state(s); multi‑state licensure if serving multiple states. Minimum 3 years of clinical experience (or equivalent background). Preferred Skills and Experiences Certification as a Case Manager. BS in a health or human services related field. Previous OB/NICU experience. Salary $67,000 to $84,000 annually (dependent on location, experience, and education). Equal Employment Opportunity 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. #J-18808-Ljbffr