Nurse Case Manager I

Elevance Health • St. Louis, MO

5d • Remote

About The Position

The Nurse Case Manager I performs care management within the scope of licensure for members with complex and chronic care needs. The role assesses, develops, implements, coordinates, monitors, and evaluates care plans designed to optimize member health care across the care continuum. Duties are performed telephonically or on-site, such as at hospitals for discharge planning.

This role is virtual full-time, except for required in-person training sessions. Candidates must reside within a reasonable commuting distance of the posting location unless an accommodation is granted as required by law. The schedule is Monday through Friday, 9:00 a.m. to 5:00 p.m. CST. The position is classified as non-management exempt and is part of the Licensed Nurse job family.

Requirements

• Bachelor’s degree in a health-related field and at least 3 years of clinical experience, or an equivalent combination of education and experience.
• Current, active, unrestricted RN license in applicable state(s).
• Multi-state licensure is required if providing services in multiple states.

Nice To Haves

• Case Manager certification.
• Bachelor’s degree in a health- or human-services-related field.
• Oncology experience.

Responsibilities

• Ensure members have access to services appropriate to their health needs.
• Conduct assessments to identify individual needs and develop care management plans with objectives and goals.
• Implement care plans by facilitating authorizations and referrals within the benefits structure or through extra-contractual arrangements.
• Coordinate internal and external resources to meet identified needs.
• Monitor and evaluate care plan effectiveness and modify plans as necessary.
• Interface with Medical Directors and Physician Advisors on developing care management treatment plans.
• Negotiate reimbursement rates, as applicable.
• Assist with problem-solving involving providers, claims, or service issues.
• Perform care management duties telephonically or on-site, including hospital discharge planning.

Benefits

• $3,000 sign-on bonus.
• Merit increases.
• Paid holidays.
• Paid Time Off.
• Incentive bonus programs, unless covered by a collective bargaining agreement.
• Medical insurance.
• Dental insurance.
• Vision insurance.
• Short- and long-term disability benefits.
• 401(k) with matching.
• Stock purchase plan.
• Life insurance.
• Wellness programs.
• Financial education resources.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level