The Nurse Case Manager I performs care management for members with complex and chronic needs by developing and monitoring individualized care plans. Responsibilities include coordinating internal and external resources and interfacing with Medical Directors to optimize member health outcomes.
Elevance Health
41 Remote Job Openings at Elevance Health
Perform care management for members with complex obstetric and chronic care needs by developing and monitoring individualized care plans. Coordinate internal and external resources and interface with medical directors to optimize member health outcomes.
Perform telephonic care management for members with complex and chronic needs by developing and monitoring individualized care plans. Coordinate internal and external resources and interface with Medical Directors to optimize member health outcomes.
RN Utilization Management Nurse (InPatient) – California Commercial
Elevance Health
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Full Time
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a day ago
Elevance Health
Responsible for reviewing complex inpatient cases to determine medical necessity using nursing judgment and clinical guidelines. Collaborates with healthcare providers and Medical Directors to optimize member outcomes and ensure appropriate levels of care.
The Nurse Case Manager I performs care management for members with complex and chronic needs by developing and monitoring personalized care plans. Responsibilities include coordinating internal and external resources and collaborating with Medical Directors to optimize member health outcomes.
Responsible for performing care management for members with complex and chronic needs by developing and monitoring individualized care plans. Coordinates internal and external resources and interfaces with Medical Directors to optimize member health outcomes.
The pharmacist evaluates and manages pharmaceutical selection to ensure safe, effective, and cost-efficient medication use. Key duties include conducting therapeutic class reviews, managing drug utilization reviews, and providing clinical guidance to network physicians.
The Pharmacist Consultant evaluates member medication needs and therapies to ensure appropriateness and compliance with care plans. They collaborate with physicians to counsel on alternative medications and serve as a clinical resource for disease management programs.
Responsible for interpreting and entering moderately complex prescriptions and processing prior authorizations. The role involves resolving grievances, educating members on medication adherence, and coordinating with providers to close care gaps.
Responsible for telephonic care management for members with complex and chronic needs by developing and monitoring individualized care plans. Coordinates internal and external resources and interfaces with Medical Directors to optimize member health outcomes.
Nurse Practitioner 100% Virtual, CareBridge
Elevance Health
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Full Time
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5 days ago
Elevance Health
Collaborate with physicians and families to develop and implement complex clinical care plans for adult patients with chronic conditions. Provide urgent healthcare via telephone and video modalities while coordinating resources and maintaining medical records.
Associate Medical Director - Outpatient Rehab
Elevance Health
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Full Time
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5 days ago
Elevance Health
The Associate Medical Director supports medical management staff by ensuring timely and consistent medical necessity decisions for members and providers. Responsibilities include conducting clinical case reviews, handling grievances and appeals, and performing physician-to-physician calls.
Perform limited and full desk reviews on providers and act as the in-charge auditor for small, less complex audits. Analyze data to make recommendations and prepare detailed work papers in accordance with GAS and CMS requirements.
The associate reviews clinical information to assess medical necessity and ensure consistent administration of plan benefits. Responsibilities include conducting precertification and retrospective reviews while referring complex cases to senior staff or Medical Directors.
Workforce Management Analyst I - Real Time Analyst
Elevance Health
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Full Time
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5 days ago
Elevance Health
Monitor real-time call volume and average speed of answer to adjust workforce schedules and maximize service levels. Manage call routing and schedule off-phone activities based on forecasted patterns and staffing availability.
The specialist ensures member treatment plans are followed for moderately complex cases and identifies ways to improve member health. Responsibilities include coordinating follow-up care, assessing compliance, and coaching members to reduce health risks.
The Nurse Case Manager II manages care for members with complex and chronic needs by developing and monitoring individualized care plans. They coordinate internal and external resources and interface with Medical Directors to optimize member health outcomes.
Medical Management Clinician Senior -Licensed Nurse
Elevance Health
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Full Time
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6 days ago
Elevance Health
Responsible for reviewing clinical information to assess medical necessity and ensure consistent administration of plan benefits for complex cases. Collaborates with healthcare providers and leadership to improve utilization review processes and health outcomes for members.
The Nurse Case Manager II manages care for members with complex and chronic needs by assessing, implementing, and monitoring personalized care plans. They coordinate internal and external resources and collaborate with Medical Directors to optimize member health outcomes telephonically.
The clinician is responsible for reviewing clinical information to assess medical necessity and ensure consistent administration of plan benefits for complex cases. They serve as a resource for junior clinicians and collaborate with leadership on process improvement initiatives.
Associate Manager Clinical Support - CareBridge
Elevance Health
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Full Time
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7 days ago
Elevance Health
Oversees the day-to-day workflow of clinical support staff and serves as a subject matter expert in administrative and operational processes. Responsibilities include solving complex provider issues, streamlining processes for accuracy, and managing direct reports through hiring and performance evaluation.
Manager Patient Engagement Specialist, Transitions of Care, Carebridge, 100% Remote
Elevance Health
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Full Time
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7 days ago
Elevance Health
Provides oversight of a customer service unit, including the establishment of department policies and procedures. Responsible for hiring, training, coaching, and evaluating the performance of direct reports.
The Coding Analyst Sr. is responsible for reviewing, auditing, and coding medical records for reimbursement, training, education, and compliance. This includes querying physicians for unclear documentation and training others on coding guidelines.
The pharmacist will manage the selection and utilization of pharmaceuticals and support core clinical programs. Responsibilities include researching clinical data, preparing therapeutic class reviews, and serving as a clinical resource to other pharmacists.
The lead ensures high-quality, cost-effective care by assessing the medical necessity of inpatient and outpatient services using medical policies and industry standards. They serve as a team lead for complex medical issues and collaborate with medical directors and providers to facilitate member care transitions.
Behavioral Health Care Manager II - ABA - GA/NC
Elevance Health
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Full Time
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13 days ago
Elevance Health
Responsible for managing ABA pre-certification health benefits through telephonic or written reviews using clinical judgment and UM guidelines. The role involves assessing member needs, reviewing case planning, and serving as a resource for other Behavioral Health Care Managers.
The Outreach Care Specialist ensures member treatment plans are followed and identifies ways to improve member health and quality goals. Responsibilities include coordinating follow-up care, assessing compliance, and referring members to funded programs.
Manage ABA pre-certification health benefits through telephonic or written reviews using clinical judgment and screening criteria. Coordinate and evaluate ABA assessments and case planning to optimize member health outcomes and resource use.
Manage ABA pre-certification health benefits through telephonic or written reviews using clinical judgment and screening criteria. Coordinate and evaluate ABA assessments and case planning to optimize member health outcomes and resource use.
Transitions of Care RN 100% Virtual, CareBridge
Elevance Health
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Full Time
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16 days ago
Elevance Health
The Transitions of Care RN provides patient education, disease management interventions, and health coaching for members with chronic diseases. They conduct clinical assessments and coordinate care plans with providers and community agencies to improve member health outcomes.
Responsible for researching, analyzing, and resolving complex claims issues and regulatory complaints for the Health Plan. This includes managing dispute escalations, performing quality reviews, and handling complex system issues.
Responsible for auditing inpatient medical records to ensure coding and DRG assignment accuracy and generating high-quality recoverable claims. The role involves analyzing claims using clinical guidelines and ICD-10 expertise to substantiate audit findings.
Pharmacy Customer Associate – BioPlus Specialty Pharmacy
Elevance Health
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Full Time
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21 days ago
Elevance Health
The Pharmacy Customer Associate handles basic customer inquiries via phone and written correspondence regarding retail and mail order prescriptions. They coordinate with internal functions to resolve customer requests and guide users on available technology and resources.
Primary Care Nurse Practitioner, 100% Virtual
Elevance Health
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Full Time
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a month ago
Elevance Health
Provide primary and acute care via telephone and video to patients in home and community-based settings. Collaborate with physicians and families to develop and implement complex clinical plans of care for adult patients with chronic conditions.
Responsible for clinical quality documentation, coding, and value capture through detailed chart reviews. The role ensures accurate diagnosis codes for HCC/Risk Adjustment and closes HEDIS care opportunities to support health plan success.
Primary Care Nurse Practitioner, 100% Virtual
Elevance Health
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Full Time
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a month ago
Elevance Health
Collaborate with physicians and families to develop and implement complex clinical plans of care for adult patients with chronic conditions. Provide primary and acute care via telephone and video modalities while coordinating resources and maintaining medical records.
Nurse Practitioner 100% Virtual, CareBridge
Elevance Health
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Full Time
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a month ago
Elevance Health
Provide primary healthcare via telephone and televideo to patients in home and community-based settings. Develop and implement complex clinical care plans for adult patients with chronic medical and mental health conditions.
Bilingual Nurse Practitioner 100% Virtual, CareBridge
Elevance Health
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Full Time
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a month ago
Elevance Health
Collaborate with providers and families to develop complex care plans for adult patients with chronic conditions via virtual modalities. Provide urgent healthcare, manage medication, and coordinate resources to maximize patient health and independence.
Associate Medical Director - Post Acute Care
Elevance Health
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Full Time
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a month ago
Elevance Health
The Associate Medical Director supports medical management staff by ensuring timely and consistent medical necessity decisions for members and providers. This includes conducting clinical case reviews, making physician-to-physician calls, and handling grievances and appeals.
The Behavioral Health Care Manager I conducts utilization management reviews for mental health and substance use disorder benefits. This includes assessing member needs and coordinating care to promote quality outcomes and effective use of health benefits.
The Behavioral Health Care Manager II is responsible for managing psychiatric and substance abuse treatment through telephonic or written review. This role involves assessing member needs, coordinating care, and promoting effective use of health benefits.
