Nurse Case Manager Lead

Anticipated End Date:

2025-08-04

Position Title:

Nurse Case Manager Lead

Job Description:

Location: Overland Park KS

Hours: M – F Standard Working hours

Travel: This role enables associates to work virtually full-time, with the exception of required in-person training sessions, providing maximum flexibility and autonomy. This approach promotes productivity, supports work-life integration, and ensures essential face-to-face onboarding and skill development.

Position Overview:

Responsible for care coordination 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 and ensuring member access to services appropriate to their health needs. Performs duties telephonically or virtually as needed.
 

How You Will Make an Impact:

• Support team conducting assessments to identify individual needs and a specific care management plan to address objectives and goals as identified during assessment

• Support teams implementing 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

• Assists in problem solving with providers, claims or service issues

• Assists with development of utilization/care management policies and procedures, chairs and schedules meetings, as well as presents cases for discussion at Grand Rounds/Care Conferences and participates in interdepartmental and/or cross brand workgroups

• May require the development of a focused skill set including comprehensive knowledge of specific disease process or traumatic injury and functions as preceptor for new care management staff

• Participates in audit activities and assists supervisor with management of day-to-day activities, such as monitoring and prioritizing workflow, delivering constructive coaching and feedback, and developing associated corrective action plans at direction of the manager

• Serves as first line contact for conflict resolution. Develops training materials, completes quality audits, performs process evaluations, and tests and monitors systems/process enhancements

Required Qualifications:

• Requires a BA/BS in a health related field and 5 years of clinical experience; or any combination of education and experience, which would provide an equivalent background

• Current, unrestricted RN license in applicable state(s) required.

Preferred Qualifications:

• Experience with Kansas Medicaid Case management or Care coordination Strongly preferred

• Leadership experience preferred

• Experience in field work strongly preferred

• Advanced Microsoft office suite experience (Excel, word, Powerpoint)

• Data analysis experience preferred

Job Level:

Non-Management Exempt

Workshift:

1st 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.

Who We Are

Elevance Health is a health company dedicated to improving lives and communities – and making healthcare simpler. We are a Fortune 25 company with a longstanding history in the healthcare industry, looking for leaders at all levels of the organization who are passionate about making an impact on our members and the communities we serve.

How We Work

At Elevance Health, we are creating a culture that is designed to advance our strategy but will also lead to personal and professional growth for our associates. Our values and behaviors are the root of our culture. They are how we achieve our strategy, power our business outcomes and drive our shared success - for our consumers, our associates, our communities and our business.

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 collec