Job Description

Telephonic Nurse Case Manager II role at Elevance Health This role enables associates to work virtually full-time, with required in-person training sessions. It provides maximum flexibility and autonomy, promotes productivity, supports work‑life integration, and offers essential face‑to‑face onboarding and skill development. 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. Work schedule: Monday‑Friday, 10:00 – 18:30 EST. Federal Employee Program – FEP, a proud member of the Elevance Health, Inc. family of companies, reflects our commitment to greater access to care for our members, greater value for our customers, and greater health for our communities. The Telephonic Nurse Case Manager II is responsible for care management within the scope of licensure for members with complex and chronic care needs. Responsibilities include assessing, developing, implementing, coordinating, monitoring, and evaluating care plans designed to optimize member health care across the continuum. Duties are performed telephonically or on-site, such as at hospitals for discharge planning. How You Will Make An Impact 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 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. Interfaces with Medical Directors and Physician Advisors on the development of care management treatment plans. Negotiates rates of reimbursement, as applicable. Assists in problem solving with providers, claims or service issues. Assists with development of utilization/care management policies and procedures. Minimum Requirements Requires BA/BS in a health related field and minimum of 5 years of clinical experience; or any combination of education and experience that provides an equivalent background. Current, unrestricted RN license in applicable state(s) required. Multi‑state licensure required if services are provided in multiple states. Preferred Skills, Capabilities, And Experiences Certification as a Case Manager is preferred. BS in a health or human services‑related field is preferred. OB experience is strongly preferred. NICU experience is a plus. Strong oral, written, and interpersonal communication skills, problem‑solving skills, facilitation skills, and analytical skills. Knowledge of the medical management process and the ability to interpret and apply member contracts, member benefits, and managed care products is strongly preferred. Prior managed care experience is strongly preferred. Salary range: $76,944 to $126,408 for positions in Colorado, Washington State, and Nevada. In addition to your salary, Elevance Health offers a comprehensive benefits package, incentive and recognition programs, equity stock purchase, and 401(k) contribution. Elevance Health is fully committed to ensuring equal pay opportunities for equal work regardless of gender, race, or any other category protected by federal, state, and local pay equity laws. Elevance Health is an Equal Employment Opportunity employer and all qualified applicants will receive consideration for employment without regard to age, citizenship status, color, creed, disability, ethnicity, genetic information, gender (including gender identity and gender expression), marital status, national origin, race, religion, sex, sexual orientation, veteran status or any other status protected by applicable laws. Applicants who require accommodation to participate in the job application process may contact elevancehealthjobssupport@elevancehealth.com for assistance. Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state, and local laws, including, but not limited to, the Los Angeles County Fair Chance Ordinance and the California Fair Chance Act. #J-18808-Ljbffr Elevance Health

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