Nurse Case Manager

Elevance Health

Nurse Case Manager I at Elevance Health managing care management for members with chronic needs. Responsibilities include assessments, plan implementation, and compliance monitoring.

Posted 5/27/2026full-timeMiami • Florida • 🇺🇸 United StatesMid-LevelSeniorWebsite

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.
Ensure compliance with healthcare regulations and monitor adherence to contractual obligations.
Ability to handle unexpected changes in assignments and members needs and manage a flexible schedule accommodating field visits and emergency situations.
Valid driver’s license, reliable transportation, and ability to travel within the service area as needed.
Conduct facility, hospital, or home visits to monitor and evaluate care as applicable and/or required.
Maintaining meticulous records of interactions, decisions, and care plans for compliance and audit purposes.
Proficiency in using mobile devices, multiples systems, and technology to access member records, document visits and reports, and communicate with the central office.
Competence in addressing quickly arising issues effectively, often requiring creative and immediate solutions.

Requirements

What you’ll need

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.
Certification as a Case Manager is preferred.
Prior hospital experience is preferred.

Benefits

Comp & perks

merit increases
paid holidays
Paid Time Off
incentive bonus programs
medical
dental
vision
short and long term disability benefits
401(k) +match
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

care managementclinical assessmenttreatment planningnegotiationrecord keepingproblem solvingcompliance monitoringflexible schedulingmobile device proficiencydocumentation

Soft Skills

interpersonal communicationadaptabilitycreativityorganizational skillstime management

Certifications

RN licenseCase Manager certification