Nurse Case Manager I

Nurse Case Manager I Location Any Elevance Health PulsePoint office in Virginia. Ashburn, VA is preferred. Virtual This role enables associates to work virtually full-time, except for 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. 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 accommodation is granted as required by law. Responsibilities 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. Minimum Requirements Requires BA/BS in a health‑related field and minimum of 3 years of clinical experience or an equivalent combination of education and experience. Current, unrestricted RN license in applicable state(s) required; multi‑state licensure if providing services in multiple states. For URAC accredited areas: requires BA/BS and 3 years of clinical care experience or equivalent; current and active RN license required; multi‑state licensure if applicable. Certification as a Case Manager and a BS in a health or human services related field is preferred. Preferred Skills Previous case management experience. Behavioral Health and/or experience working with individuals with intellectual/developmental disabilities. Home health experience, utilization management and/or hospital discharge planning experience. Salary The salary range for this position is $67,200 to $115,920. Equal Employment Opportunity / 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. Applicants who require accommodation to participate in 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