Nurse Case Manager I

Elevance Health

Nurse Case Manager I performing care management for members with complex healthcare needs. Assisting in evaluating and coordinating care plans to optimize member health outcomes.

Posted 6/10/2026full-timeMiami • Florida • 🇺🇸 United StatesMid-LevelSeniorWebsite

About the role

Key responsibilities & impact

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 for discharge planning
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 (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
financial education resources

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills & Tools

care managementassessmentscare plansauthorizationsreferralscompliance monitoringrecord keepingproblem solvingnegotiationclinical experience

Soft Skills

flexibilitycommunicationcreativityorganizational skillsinterpersonal skillsadaptabilitycritical thinkingtime managementcollaborationempathy

Certifications

RN licenseCase Manager certification