Nurse Case Manager I

Location Cincinnati, Columbus, Mason and Seven Hills OH offices and surrounding areas; this is a field‑based role with some virtual work. Field This role enables associates to primarily operate in the field, traveling to client sites or designated locations as required, with occasional office attendance for meetings or training. This approach ensures flexibility, responsiveness to client needs, and direct, hands‑on engagement. 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 accommodation is granted as required by law. Shift Monday – Friday; 8:30 am – 5:00 pm EST. No weekends or holidays required. Role Overview The Nurse Case Manager I is 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 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. 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 that 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: requires BA/BS and 3 years of clinical care experience; or any combination of education and experience that would provide an equivalent background. Preferred Skills, Capabilities and Experiences Certification as a Case Manager and a BS in a health or human services related field preferred. Previous OB/NICU experience preferred. Compensation and Benefits Salary range: $67,000 – $84,000. This range is based on location, experience, education, and skill level and may be modified in the future. Benefits include a comprehensive package, incentive and recognition programs, equity stock purchase, and 401(k) contribution (subject to eligibility). Additional benefits such as medical, dental, vision, short‑ and long‑term disability, paid holidays, paid time off, and wellness programs may be available. Salary offered is based on legitimate, non‑discriminatory factors set by the Company and may be adjusted according to market and business considerations. Equal Employment Opportunity 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. Applicants who require accommodation for the job application process may contact View email address on click.appcast.io for assistance. Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state, and local laws, including, but not limited to, the Los Angeles County Fair Chance Ordinance and the California Fair Chance Act. Prospective employees required to be screened under Florida law should review the education and awareness resources at HB531 | Florida Agency for Health Care Administration. #J-18808-Ljbffr Elevance Health