Job Description

Telephonic Nurse Case Manager II Location: This role enables associates to work virtually full‑time, with the exception of required in‑person training sessions, providing maximum flexibility and autonomy. Alternate locations may be considered if candidates reside within a commuting distance from an office. Hours: Monday – Friday 9:00 am to 5:30 pm EST and 1 late evening 11:30 am to 8:00 pm EST. Pre‑employment assessment: This position requires an online pre‑employment skills assessment. The assessment is free of charge and can be taken from any PC with Internet access. Candidates who meet the minimum requirements will be contacted via email with instructions. Candidates must complete the assessment within 48 hours of receipt and meet the criteria. Responsibilities Ensures member access to services appropriate to their health needs. Conducts assessments to identify individual needs and specific care management plan. Implements care plan by facilitating authorizations/referrals within benefits structure or 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 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 clinical experience; or equivalent education and experience. Current, unrestricted RN license in applicable state(s). Multi‑state licensure if providing services in multiple states. Preferred Capabilities, Skills, and Experiences Certification as a Case Manager preferred. Ability to talk and type at the same time preferred. Demonstrate critical thinking skills when interacting with members preferred. Experience with Microsoft Office and/or ability to learn new computer programs/systems/software quickly preferred.Ability to manage, review and respond to emails/instant messages timely preferred. Minimum 2 years’ experience in acute care setting preferred. Minimum 2 years’ telephonic case management experience with a Managed Care Company preferred. Managed Care experience preferred. Salary & Locations Salary range: $79,464 – $130,548. Locations: Maryland, New Jersey. In addition to your salary, Elevance Health offers a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401(k) contribution. Equal Employment Opportunity 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 expression), marital status, national origin, race, religion, sex, sexual orientation, veteran status or any other status or condition protected by applicable federal, state, or local 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. Prospective employees required to be screened under Florida law should review the education and awareness resources at HB531 | Florida Agency for Health Care Administration. #J-18808-Ljbffr Elevance Health

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