Nurse Case Mgr

Overview

Nurse Case Manager I

Hours:

9:00am–5:30pm with 2–3 late evenings a month; 11:30am–8:00pm.

Location:

This role enables associates to work virtually full-time, with required in-person training sessions. Per our hybrid/virtual policy, candidates not within a reasonable commuting distance from the posting location will not be considered unless an accommodation is granted as required by law.

• The Nurse Case Manager I is responsible for 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 (e.g., at hospitals for discharge planning).
• Ensure member access to services appropriate to their health needs.
• Conduct assessments to identify individual needs and develop a specific care management plan to address objectives and goals identified during assessment.
• Implement care plans by facilitating authorizations/referrals as appropriate within benefits structure or through extra-contractual arrangements.
• Coordinate internal and external resources to meet identified needs.
• Monitor and evaluate the effectiveness of the care management plan and modify as necessary.
• Interface with Medical Directors and Physician Advisors on the development of care management treatment plans.
• Negotiate rates of reimbursement, as applicable.
• Assist in problem solving with providers, claims, or service issues.
• Assist with development of utilization/care management policies and procedures.

• Requires BA/BS in a health-related field and a 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 providing services in multiple states.

• Certification as a Case Manager is preferred.
• BS in a health or human services related field preferred.

For candidates working in person or virtually in the location(s) below, the salary range for this position is $68,880–$103,320.

Locations:
New York.

Elevance Health offers a comprehensive benefits package, incentive programs, equity stock purchase and 401(k) contributions (eligibility applies). The salary range is provided as a guide and may be modified based on geographic location, experience, education, and skill level. The company is committed to equal pay opportunities and equal employment opportunity for all qualified applicants.

The company operates with a Hybrid Workforce Strategy. Unless specified as primarily virtual by the hiring manager, associates are required to work at an Elevance Health location at least once per week, and possibly several times per week. Vaccination requirements for certain patient/member-facing roles may apply according to federal, state, and local laws.

Elevance Health is an Equal Employment Opportunity employer. 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 in accordance with applicable laws.