Nurse Case Manager II (RN)

Anticipated End Date: 2026-10-27

Job Description:

The Nurse Case Manager II (RN) is responsible for care management within the scope of licensure for members with complex and chronic care needs. Care management is conducted through screening, assessing, stratifying risk, planning, implementing (care coordination), following up, transitioning (transitional care), communicating post transition, and evaluating members. Our care model is designed to optimize member health care across the care continuum. We provide meaningful interventions that drive improvements in clinical outcomes, productivity, and quality of life. This is an outbound calling program, 100% telephonic.

How you will make an impact:

• 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.
• Assists in 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 other health professionals 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.

Minimum Requirements:

• Requires 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 applicable state(s) is required.
• Multi-state RN licensure is required for providing services in multiple states upon hire.

Preferred Skills, Capabilities and Experiences:

• Active California RN license is highly preferred.
• Minimum 2 years of direct Case Management experience.
• Certification as a Case Manager, CCM is preferred.
• Telephonic and/or virtual nursing experience.
• Managed Care experience.
• Minimum 2 years’ experience in acute care setting.
• Experience with Microsoft Office suite and/or ability to learn new computer programs/systems/software quickly.
• Ability to speak and type at the same time.

For candidates working in person or virtually in the below locations, the salary range for this specific position is $79,464 to $130,548.

Location(s): California, Colorado, Nevada, Washington

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).

The salary offered for this specific position is based on a number of legitimate, non-discriminatory factors set by the Company.

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.