Nurse Case Manager I
Elevance Health

Job Description

Preferred Location: Florida. This position will work partly remote and the other part in the field. The ideal candidate will live within 50 miles of one of our Elevance Health PulsePoint locations.

Nurse Case Manager I

Responsible for performing care management 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. Performs duties telephonically or on-site such as at hospitals for discharge planning.

**Ideal candidate MUST reside and licensed in the state of Florida.**

**Fingerprint screening is REQUIRED.**

**Monday-Friday 8 am - 5 pm or 9 am - 6 pm EST.**

**Travel will be required as this role is predominantly working in the field.**

**Ideal candidate must have experience working with the pediatric population.**

**Candidates that reside in the following counties are STRONGLY encouraged to apply:

Hernando County (city- Springhill FL)

Broward County (City- Ft. Lauderdale) Palm Beach County ( City- West Palm Beach, Boca Raton, Boynton Beach, Delray Beach, Jupiter, Palm Beach Gardens, Greenacres, Lake Worth Beach, Royal Palm Beach)

Duval County (City- Jacksonville)

St. Johns County ( City- St. Augustine)**

How will you 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.
• Implements 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.
• Negotiates rates of reimbursement, as applicable.
• Assists in problem solving with providers, claims or service issues.

• Requires BA/BS in a health-related field and minimum of 3 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.
• Multi-state licensure is required if this individual is providing services in multiple states.

• Strong oral, written, and interpersonal communication skills, problem-solving skills, facilitation skills, and analytical skills preferred.
• Certification as a Case Manager is preferred.