Nurse Case Manager Senior - Field Nurse

Elevance Health

111d

About The Position

The Nurse Case Manager Senior - Field Nurse 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. This field-based role located in the Albany, GA area enables associates to primarily operate in the field, traveling to client sites or designated locations as their role requires, with occasional office attendance for meetings or training. This approach ensures flexibility, responsiveness to client needs, and direct, hands-on engagement. The work schedule is Monday - Friday 8:00am to 5:00pm EST with 1 late evening shift 11:00am to 7:30pm EST. This position does involve traveling to attend health plan-sponsored events, individual and group presentations, but does not involve in-home or facility-based visits.

Requirements

• Requires BA/BS in a health-related field and minimum of 5 years of clinical experience; or any combination of education and experience, which would provide an equivalent background.
• Current, unrestricted RN license in applicable state(s) required.

Nice To Haves

• Nursing experience in Home Health, Managed Care, Case Management, or Care Coordination.
• Case Management Certification.
• Strong communication and presentation skills.

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.
• Assists in problem solving with providers, claims or service issues.
• Coordinates referrals to local and statewide resources including behavioral health, housing, transportation, and food assistance.
• Partners with community health organizations, advocacy groups, and outreach teams to strengthen member connections.
• Plans, coordinates, and delivers educational events in collaboration with community partners, employers, or local health organizations.
• Provides group-based and one-on-one education on chronic conditions, medication adherence, preventive screenings, nutrition, and self-care.
• Supports initiatives that address health equity and promote culturally responsive care.
• Assists with development of utilization/care management policies and procedures, chairs and schedules meetings, and presents cases for discussion at Grand Rounds/Care Conferences.
• Participates in interdepartmental and/or cross brand workgroups.
• May require the development of a focused skill set including comprehensive knowledge of specific disease process or traumatic injury and functions as preceptor for new care management staff.
• Participates in department audit activities.

Benefits

• Merit increases
• Paid holidays
• Paid Time Off
• Incentive bonus programs
• Medical, dental, vision benefits
• Short and long term disability benefits
• 401(k) + match
• Stock purchase plan
• Life insurance
• Wellness programs
• Financial education resources

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: Bachelor's degree
• Number of Employees: 5,001-10,000 employees