RN Nurse Case Manager II (10:30am – 7:00pm Central Time)

Anticipated End Date: 2025-04-10

Position Title: RN Nurse Case Manager II (10:30am – 7:00pm Central Time)

Job Description:

RN Nurse Case Manager II (10:30am – 7:00pm Central Time) JR144435

Work Hours: Monday – Friday, 10:30am – 7pm Central Time

Locations: This position is telephonic. It is preferred that candidates reside within 50 miles of one our open PulsePoint locations.

The Nurse Case Manager II is responsible for telephonic 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 such as at hospitals for discharge planning. 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 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:

• 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 state of residence required.
• Multi-state licensure OR compact license in state of residence is required.

Preferred Qualifications:

• Certification as a Case Manager is preferred.
• Formal Case Management experience within Managed Care or Hospital setting.
• Strong clinical background in hospital setting, i.e. ER, ICU, Critical Care.

For candidates working in person or remotely in the below location(s), the salary range for this specific position is $73,280 to $120,912.

Locations: Colorado; Illinois; Minnesota; Nevada.

In addition to your salary, Elevance Health offers benefits such as a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements).

Job Level: Non-Management Exempt

Workshift: 2nd Shift (United States of America)

Job Family: MED > Licensed Nurse

Please be advised that Elevance Health only accepts resumes for compensation from agencies that have a signed agreement with Elevance Health. Any unsolicited resumes, including those submitted to hiring managers, are deemed to be the property of Elevance Health.