Job Title

Remote Nurse Case Manager Location: This role allows associates to work virtually full-time, providing maximum flexibility and autonomy. This model enhances productivity and supports work-life integration while ensuring essential face-to-face onboarding and skill development during required in-person training sessions. Candidates residing within commuting distance from an office may also be considered for alternate locations. Please note that, as per our policy on hybrid/virtual work, candidates not residing within a reasonable commuting distance will not be considered for employment unless an accommodation is granted as required by law. Hours: Monday - Friday 9:00am to 5:30pm EST. Late evenings may be necessary during peak periods (11:30 AM to 8:00 PM). This position requires an online pre-employment skills assessment. The assessment is free and can be completed from any PC with internet access. Candidates who meet the minimum requirements will be contacted via email with instructions. Completion of the assessment within 48 hours is necessary to proceed in the hiring process. The Remote Nurse Case Manager plays an essential role in managing care for members with complex and chronic needs. This position involves assessing, developing, implementing, coordinating, monitoring, and evaluating care plans to optimize member healthcare across various settings, primarily through phone communication with members and providers. Key Responsibilities: Ensure members access services tailored to their unique health needs. Conduct comprehensive assessments to identify specific needs and design effective care management plans that align with individual goals. Facilitate authorizations and referrals to implement care plans within the benefits structure or through alternative arrangements. Cooperate with both internal and external resources to address identified needs. Continuously monitor and evaluate care management plans, making adjustments as necessary to enhance effectiveness. Collaborate with Medical Directors and Physician Advisors to create holistic treatment plans. Negotiate reimbursement rates as necessary. Assist in resolving provider, claims, and service-related issues. Contribute to developing utilization and care management policies and procedures. Minimum Requirements: A BA/BS in a health-related field combined with a minimum of 5 years of clinical experience; or equivalent education and experience. A current, unrestricted RN license in applicable state(s) is mandatory. Multi-state licensure is required if services are provided across multiple states. For URAC accredited areas, the following requirements apply: Requires a BA/BS and a minimum of 5 years of clinical care experience; or an equivalent combination of education and experience. A current active RN license is required in applicable state(s). Multi-state licensure is necessary for providing services in multiple states. Preferred Skills and Experience: Certification as a Case Manager is advantageous. Ability to multitask, specifically to talk and type simultaneously, is preferred. Demonstrated critical thinking skills in member interactions are desirable. Proficient in Microsoft Office and quick adaptability to new software applications are preferred. Prompt management and response to emails and instant messages are preferred. A minimum of 2 years' experience in an acute care setting is preferred. A minimum of 2 years of telephonic Case Management experience with a Managed Care Company is preferred. Experience in Managed Care is a plus. For candidates working in person or virtually, the salary range for this position is $79,464 to $130,548. In addition to your salary, Elevance Health offers a robust benefits package, including incentive and recognition programs, equity stock purchase options, and 401k contributions (subject to eligibility requirements). The offered salary for this position is determined by various legitimate, non-discriminatory factors. Elevance Health is dedicated to ensuring equal pay opportunities for all employees regardless of gender, race, or any other protected category. Please be aware that Elevance Health accepts resumes only from agencies with a signed agreement; any unsolicited resumes are considered the property of Elevance Health. About Us Elevance Health is a health company committed to improving lives and communities while simplifying healthcare. As a Fortune 25 company with a rich history in the healthcare sector, we seek passionate professionals at all levels eager to make a meaningful impact on our members and communities. Culture and Work Environment At Elevance Health, we foster a culture aimed at advancing our strategy and promoting both personal and professional growth for our associates. Our core values drive our culture, influencing our business outcomes and shared success. We provide a range of competitive rewards, including merit increases, paid holidays, Paid Time Off, and incentive bonus programs, along with benefits like medical, dental, vision, disability insurance, 401(k) matching, stock purchase plans, life insurance, wellness programs, and financial education resources. Elevance Health operates under a Hybrid Workforce Strategy, where, unless specified, associates are required to work at an Elevance Health location at least once a week. Specific onsite expectations will be communicated during the hiring process. The health of our associates and communities is paramount to Elevance Health. As such, all new candidates in certain patient/member-facing roles must be vaccinated against COVID-19 and Influenza. Unvaccinated candidates may have offers rescinded unless an acceptable explanation is provided. Elevance Health is an Equal Employment Opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, creed, gender, national origin, or any protected status under applicable laws. Applicants requiring accommodations during the application process may contact Elevance Health for assistance. Qualified applicants with arrest or conviction records will be considered for employment in accordance with applicable laws.