Nurse Care Manager I

Elevance Health • Waukesha, OH

1d • Remote

About The Position

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. Location: Columbus, Cincinnati, Mason, Seven Hills, OH, Louisville, KY, St. Louis, MO and Waukesha, WI. 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. The Nurse Care Manager I will be 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.

Requirements

• Requires a HS diploma or equivalent and a minimum of 3 years of acute care clinical experience; or any combination of education and experience, which would provide an equivalent background.
• Current, active valid 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, the following applies: Current and active RN license required in applicable state(s) that allows for an independent assessment to be conducted within their scope of practice.
• Requires 3 years full-time equivalent of direct clinical care experience to the consumer.

Nice To Haves

• Home health/discharge planning experience preferred.
• AS or BS in nursing preferred.
• Previous utilization management experience preferred.
• Prior case management experience preferred.
• Certification as a Case Manager is preferred.
• For URAC accredited areas, 5 years full-time equivalent of direct clinical care experience to the consumer preferred or any combination of education and experience, which would provide an equivalent background.
• Certification as a Case Manager or a BS in a health or human services related field also preferred.

Responsibilities

• Ensures member access to services appropriate to their health needs.
• Coordinates internal and external resources to meet identified needs.
• Partners with physician clinical reviewers and/or medical directors to interpret appropriateness of care, intervention planning, and general clinical guidance.
• Collaborates with providers to assess consumer needs for early identification of and proactive planning for discharge.
• Conducts clinical assessment to develop goals that address individual needs in order to develop and implement a care plan.
• Monitors and evaluates effectiveness of the care management plan and modifies as necessary.

Benefits

• comprehensive benefits package
• incentive and recognition programs
• equity stock purchase
• 401k contribution
• paid holidays
• Paid Time Off
• incentive bonus programs
• medical, dental, vision, short and long term disability benefits, 401(k) +match, stock purchase plan, life insurance, wellness programs and financial education resources

What This Job Offers

• Job Type: Full-time
• Career Level: Entry Level
• Education Level: High school or GED