Elevance Health is fueled by a purpose to strengthen the health of humanity by redefining health, reimagining the health system, and improving communities. Reco
Nurse Care Manager I
Location
United States
Posted
20 hours ago
Salary
Not specified
Seniority
Lead
Job Description
Anticipated End Date:
2026-03-21Position Title:
Nurse Care Manager IJob Description:
Shift: Monday – Friday; 2:30pm ET - 11:30pm EST
Location: Virtual; Alternate locations may be considered if candidates reside within a commuting distance from an office
Virtual: 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.
Please note that per our policy on hybrid/virtual work, candidates not within a reasonable commuting distance from the posting location(s) will not be considered for employment, unless an accommodation is granted as required by law
The Nurse Care Manager I 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 and extensions of stay, 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 and implement a care plan.
Monitors and evaluates effectiveness of the care management plan and modifies as necessary.
Minimum requirements:
Requires a HS diploma or equivalent and a minimum of 3 years of acute care clinical experience; or any combination of education and experience, which would provide an equivalent background.
Current, active valid 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:
Home health/discharge planning experience preferred.
AS or BS in nursing preferred.
Certification as a Case Manager is preferred.
For URAC accredited areas, the following applies: Current and active RN license required in applicable state(s) that allows for an independent assessment to be conducted within their scope of practice. Requires 3 years full-time equivalent of direct clinical care experience to the consumer, 5 years full-time equivalent of direct clinical care experience to the consumer preferred or any combination of education and experience, which would provide an equivalent background, Multi-state licensure is required if this individual is providing services in multiple states. Certification as a Case Manager or a BS in a health or human services related field also preferred.
Job Level:
Non-Management Non-ExemptWorkshift:
1st Shift (United States of America)Job Family:
MED > Licensed NursePlease 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 manager, associates are required to work at an Elevance Health location at least once per week, and potentially several times per week. Specific requirements and expectations for time onsite will be discussed as part of the hiring process.
The health of our associates and communities is a top priority for Elevance Health. We require all new candidates in certain patient/member-facing roles to become vaccinated against COVID-19 and Influenza. If you are not vaccinated, your offer will be rescinded unless you provide an acceptable explanation. Elevance Health will also follow all relevant federal, state and local laws.
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 gender 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.
Job Requirements
- Requires a HS diploma or equivalent and a minimum of 3 years of acute care clinical experience; or any combination of education and experience, which would provide an equivalent background.
- Current, active valid unrestricted RN license in applicable state(s) required.
- Multi-state licensure is required if this individual is providing services in multiple states.
- Home health/discharge planning experience preferred.
- AS or BS in nursing preferred.
- Certification as a Case Manager is preferred.
- For URAC accredited areas, the following applies:
- Current and active RN license required in applicable state(s) that allows for an independent assessment to be conducted within their scope of practice.
- Requires 3 years full-time equivalent of direct clinical care experience to the consumer, 5 years full-time equivalent of direct clinical care experience to the consumer preferred or any combination of education and experience, which would provide an equivalent background.
- Certification as a Case Manager or a BS in a health or human services related field also preferred.
Benefits
- Market-competitive total rewards including merit increases.
- Paid holidays and Paid Time Off.
- Incentive bonus programs (unless covered by a collective bargaining agreement).
- Medical, dental, and vision benefits.
- Short and long term disability benefits.
- 401(k) + match.
- Stock purchase plan.
- Life insurance.
- Wellness programs and financial education resources.
Related Guides
Related Categories
Related Job Pages
More Clinical Operations Jobs
The Senior Clinical Specialist provides comprehensive engineering, sales, educational, and technical support, acting as a senior clinical interface between the medical community and the business regarding Cardiac Rhythm Management products. Key duties include providing regional case coverage, developing and leading training sessions for healthcare professionals, and mentoring less experienced specialists.
The Senior Vice President Operations provides matrixed leadership across R&D, strategizing, planning, and executing programs from development candidate selection through regulatory approval and commercial launch preparation. This role also oversees the delivery of all clinical research activity, including trial execution, documentation, analysis, reporting, and the development of Medical Affairs activities.
Medical Management Clinician Associate-Licensed Nurse
Elevance HealthElevance Health is fueled by a purpose to strengthen the health of humanity by redefining health, reimagining the health system, and improving communities. Reco
The clinician is responsible for ensuring appropriate and consistent administration of plan benefits by reviewing clinical information and assessing medical necessity against relevant guidelines and medical policies. This role focuses on less complex and potentially higher volume benefit plans, following standard procedures that do not require the full training of a registered nurse.
Strategic Clinical Quality Manager - Colorado/New Mexico Home Therapy
Fresenius Medical CareCreating a future worth living. For patients. Worldwide. Every day.
The Clinical Quality Manager develops, implements, and monitors Quality Assurance and Performance Improvement (QAPI) programs to ensure high standards of patient care and regulatory compliance across assigned treatment modalities. This role involves leading quality initiatives, coordinating clinical outcomes, ensuring adherence to regulations, and collaborating with the interdisciplinary team to drive continuous improvement.
