Telephonic Nurse Case Manager

Telephonic Nurse Case Manager I

Location: 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.

Work Schedule: Monday to Friday from 9:00 AM to 5:30 PM EST, with 2‑4 late evening shifts per month from 11:30 AM to 8:00 PM EST.

Multi‑State Licensure: Required for providing services in multiple states.

Description: The Telephonic 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. All duties are performed telephonically.

• 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.
• 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.

• Requires BA/BS in a health‑related field and minimum of 3 years of clinical experience; or any combination of education and experience providing an equivalent background.
• Current unrestricted RN license in applicable state(s) required.
• Multi‑state licensure is required if this individual provides services in multiple states.

• Certification as a Case Manager.

The salary range for this position is $68,880 to $108,240 for candidates working in person or virtually in Colorado, New York, and Illinois.

In addition to salary, Elevance Health offers a comprehensive benefits package, incentive and recognition programs, equity stock purchase, 401(k) contribution, and more.

Vaccination Requirement:
All new candidates in patient/member‑facing roles must be vaccinated against COVID‑19 and influenza. Unvaccinated candidates may have offers rescinded unless an acceptable explanation is provided.

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 elevancehealthj 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.