Senior Telephonic Nurse Case Manager

Elevance Health

Telephonic Nurse Case Manager Senior at Elevance Health managing care for members with chronic needs. Responsible for assessments, care planning, and resource coordination across multiple states in the U.S.

Posted 4/29/2026full-timeGrand Prairie • Ohio, Texas, Virginia • 🇺🇸 United StatesSeniorWebsite

About the role

Key responsibilities & 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.
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 department audit activities.

Requirements

What you’ll need

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) required.
Multi-state licensure is required if this individual is providing services in multiple states.
Certification as a Case Manager preferred.
Minimum 2 years’ experience in acute care setting.
Minimum 2 years "telephonic" Case Management experience with a Managed Care Company.
Ability to talk and type at the same time.
Demonstrate critical thinking skills when interacting with members.
Experience with Microsoft Office and/or ability to learn new computer programs/systems/software quickly.
Ability to manage, review and respond to emails/instant messages in a timely fashion.

Benefits

Comp & perks

Paid Time Off
401(k) +match
Incentive bonus programs
Medical, dental, vision benefits
Short and long term disability benefits
Stock purchase plan
Life insurance
Wellness programs
Financial education resources

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills & Tools

clinical experiencecare managementutilization managementtelephonic case managementnegotiationproblem solvingassessmentcare plan developmentmonitoring and evaluationdisease process knowledge

Soft Skills

critical thinkingcommunicationinterpersonal skillsorganizational skillspresentation skillsteam collaborationleadershiptime managementadaptabilityconflict resolution

Certifications

RN licenseCase Manager certification