Nurse Care Mgr II

Anticipated End Date:

2025-05-29

Position Title:

Nurse Care Mgr II

Job Description:

Nurse Care 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. This approach promotes productivity, supports work-life integration, and ensures essential face-to-face onboarding and skill development.

Work Schedule:  Monday - Friday 9 pm - 6 pm EST.

The Nurse Care Manager II is responsible for collaborating with healthcare providers and/or consumer to drive personalized health management and improve health outcomes for optimal consumers. Performs care management activities within the scope of licensure for members with complex and chronic care needs.

How you will make an Impact: 

• Ensures medically appropriate, high-quality, cost-effective care through assessing the medical necessity of inpatient admissions, outpatient services, out-of-network services, and appropriateness of treatment setting and level of care.

• Partners with physician clinical reviewers and/or medical directors to interpret appropriateness of care, intervention planning, and general clinical guidance.

• Collaborates with providers to assess consumer needs for early identification of and proactive planning for discharge.

• Conducts clinical assessment to develop goals that address individual needs in order to develop a care plan; implements and coordinates a care plan.

• Monitors and evaluates effectiveness of the care management plan and modifies as necessary.

• Assists with the development of utilization/care management policies and procedures.

• Participates in or leads intradepartmental teams, projects, and initiatives.

Minimum Requirements:

• Requires a HS diploma or equivalent and a minimum of 3 years of acute care clinical experience, condition specific clinical experience, home health/discharge planning experience and a minimum of 1 year in a Nurse Care Mgr I role or equivalent experience; or any combination of education and experience, which would provide an equivalent background.

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

• Multi-state licensure is required if this individual is providing services in multiple states.

Preferred Skills, Capabilities, and Experiences:

• An AS or BS in nursing is preferred.

• Certification as a Case Manager is preferred.

• Participation in the American Association of Managed Care Nurses is preferred.

• Prior managed care experience is preferred.

• Knowledge of the medical management process and ability to interpret and apply member contracts, member benefits, and managed care products is strongly preferred.

Job Level:

Non-Management Non-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 collective bargaining agreement), medical, dental, vision, short and long term disability benefits, 401(k) +match, stock purchase plan, life insurance, wellness programs and financial education resources, to name a few.

Elevance Health operates in a Hybrid Workforce Strategy. Unless specified as primarily virtual by the hiring