RN Nurse Case Manager I

Elevance Health

3d • Hybrid

About The Position

Nurse Case Manager I LOCATION: Central Region. This is a field and telephonic position with potential visits to our members. When you are not in the field, you will work virtually from your home. HOURS: General business hours, Monday through Friday. TRAVEL: Occasional travel is required to members or to the office for meetings and/or specialized training. This field-based role 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. 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 an accommodation is granted as required by law. The 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. Performs duties telephonically or on-site as needed. Primary duties may include, but are not limited to: 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 plan and modifies as necessary. Interfaces with Medical Directors and Physician Advisors on the development of care management treatment plans. Assists in problem solving with providers, claims or service issues. Functions as preceptor for new care management staff. Works on special projects as assigned by manager. Other duties as assigned.

Requirements

• Requires 3 years of clinical experience; or any combination of education and experience, which would provide an equivalent background.
• Current, active, unrestricted RN license from the Commonwealth of Virginia.

Nice To Haves

• Previous case management experience is preferred.
• Behavioral Health and/or experience working with individuals with intellectual/developmental disabilities is a huge plus.
• Home health experience, utilization management and/or hospital discharge planning experience is a plus.

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 plan and modifies as necessary.
• Interfaces with Medical Directors and Physician Advisors on the development of care management treatment plans.
• Assists in problem solving with providers, claims or service issues.
• Functions as preceptor for new care management staff.
• Works on special projects as assigned by manager.

Benefits

• We offer a range of market-competitive total rewards that include merit increases, paid holidays, Paid Time Off, and incentive bonus programs (unless covered by a collective bargaining agreement), medical, dental, vision, short and long term disability benefits, 401(k) +match, stock purchase plan, life insurance, wellness programs and financial education resources, to name a few.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: No Education Listed