Telephonic Nurse Case Manager II

Elevance Health

. Provide telephonic care management for members with complex and chronic care needs .

Posted 9/22/2026full-timeUnited StatesMid-LevelSenior💰 $79,464 - $119,196 per yearWebsite

Core Competencies

Role fit

Core Competencies

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Demonstrates expertise in telephonic care management, including the development and implementation of care management plans for members with complex health needs. Proficient in coordinating resources, negotiating reimbursement rates, and ensuring access to appropriate services while maintaining compliance with managed care standards.

Highest-signal resume keywords

RN LicenseCare ManagementManaged Care ExperienceCritical Thinking SkillsMicrosoft Office Proficiency

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Care Management PlansTelephonic Care ManagementUtilization ManagementClinical AssessmentReimbursement NegotiationProblem-SolvingAcute Care ExperienceMulti-State LicensurePolicy DevelopmentReferral Coordination

Soft Skills

Communication SkillsTime ManagementInterpersonal SkillsAdaptabilityTeam Collaboration

Tools & Technologies

Microsoft OfficeElectronic Health RecordsCare Management Software

Certifications & Qualifications

Case Manager Certification

Industry Keywords

Chronic Care ManagementHealth ServicesClinical ExperienceMember AccessHealth Needs Assessment

About the role

Key responsibilities & impact

Provide telephonic care management for members with complex and chronic care needs
Assess members and develop specific care management plans
Implement care plans through authorizations and referrals within benefits structures or extra-contractual arrangements
Coordinate internal and external resources to meet identified needs
Monitor and evaluate care management plans and modify them as necessary
Interface with Medical Directors and Physician Advisors on treatment plans
Negotiate reimbursement rates as applicable
Assist with provider, claims, or service issue problem-solving
Assist with development of utilization and care management policies and procedures
Ensure member access to services appropriate to health needs

Requirements

What you’ll need

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 required when providing services in multiple states
Certification as a Case Manager is preferred
BS in a health or human services related field is a plus
Minimum 2 years’ experience in acute care setting is preferred
Managed Care experience is preferred
Ability to talk and type at the same time
Critical thinking skills when interacting with members
Experience with Microsoft Office and/or ability to learn new computer programs, systems, and software quickly
Ability to manage, review, and respond to emails/instant messages in a timely fashion
Ability to complete the online pre-employment skills assessment within 48 hours and meet the criteria
Ability to work the stated Monday–Friday EST schedules, including one late evening
Must reside within a reasonable commuting distance from a posting location unless an accommodation is granted

Benefits

Comp & perks

Comprehensive benefits package
Incentive and recognition programs
Equity stock purchase
401k contribution
Merit increases
Paid holidays
Paid Time Off
Incentive bonus programs
Medical, dental, and vision benefits
Short- and long-term disability benefits
401(k) with match
Stock purchase plan
Life insurance
Wellness programs
Financial education resources
Virtual work flexibility
Required in-person training sessions
Vaccination coverage/requirement for certain patient/member-facing roles