Telephonic Nurse Case Manager II

Elevance Health

. Provide telephonic care management for members with complex and chronic care needs within the scope of licensure .

Posted 10/15/2026full-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 for members with complex and chronic care needs, including the development and implementation of individualized care management plans. Holds a current RN license and possesses strong critical thinking and communication skills to effectively coordinate care and negotiate reimbursement.

Highest-signal resume keywords

RN LicenseCare ManagementCritical ThinkingManaged Care ExperienceTelephonic Care Coordination

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Care Management PlansClinical ExperienceUtilization ManagementReimbursement NegotiationAcute Care ExperienceMulti-State LicensurePolicy DevelopmentAssessment SkillsProblem SolvingMicrosoft Office

Soft Skills

Communication SkillsTime ManagementInterpersonal SkillsAdaptabilityTeam Collaboration

Certifications & Qualifications

Case Manager Certification

Industry Keywords

Chronic Care ManagementHealth Related FieldMember AccessTelehealthCare Coordination

About the role

Key responsibilities & impact

Provide telephonic care management for members with complex and chronic care needs within the scope of licensure
Assess members and develop individualized care management plans
Implement care plans by facilitating authorizations and referrals within the benefits structure or through extra-contractual arrangements
Coordinate internal and external resources to meet identified needs
Monitor and evaluate care plan effectiveness and modify plans as necessary
Interface with Medical Directors and Physician Advisors on care management treatment plans
Negotiate reimbursement rates, as applicable
Assist with provider, claims, or service-related problem solving
Assist with developing utilization and care management policies and procedures
Ensure member access to services appropriate to their health needs
Service members in different states

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 is required if 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
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
Must complete the online pre-employment skills assessment within 48 hours of receipt and meet the criteria
Candidates must reside within a reasonable commuting distance from the posting location(s), unless an accommodation is granted as required by law
Ability to work Monday–Friday 9:00am–5:30pm EST or 9:30am–6:00pm EST and one late evening 11:30am–8:00pm EST

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 benefits
Dental benefits
Vision benefits
Short-term disability benefits
Long-term disability benefits
401(k) + match
Stock purchase plan
Life insurance
Wellness programs
Financial education resources