Grand Prairie, Texas, United States · Hybrid
Anticipated End Date: 2026-08-14 Position Title: Nurse Case Manager I Job Description: Nurse Case Manager I Location: The ideal candidate would reside within the state of Texas. Field: This field-based role enables assoc…
Skills: Care Management, Clinical Assessment, Care Planning, Case Management, Patient Coordination
Iloilo City, Western Visayas, Philippines · On-site
Position Title: Mgr Asst Customer Care (PHL) Shift: 9:00 PM to 6:00AM (Philippines) Job Description: Responsible for serving as the operations point of contact in for day to day operations, including but not limited to, …
Skills: Performance Management, Operations Management, Staffing Coordination, Coaching, Counseling
Eureka, California, United States · Hybrid
$95k–$171k/yr
Anticipated End Date: 2026-08-14 Position Title: Regional Account Liaison - BioPlus Specialty Pharmacy - Northern California Job Description: Title: Regional Account Liaison - BioPlus Specialty Pharmacy Location(s): Cali…
Skills: Sales Strategy, Account Management, Salesforce, Customer Service, Relationship Building
Atlanta, Georgia, United States · Remote OK
$19/hr–$34/hr
Anticipated End Date: 2026-08-14 Position Title: PBM Billing Specialist Senior Job Description: PBM Billing Specialist Senior Virtual: This role enables associates to work virtually full-time, with the exception of requi…
Skills: PBM Billing, Collections, Microsoft Excel, Data Reconciliation, Billing System Database Management
Atlanta, Georgia, United States · Hybrid
$75k–$136k/yr
Anticipated End Date: 2026-08-14 Position Title: PBM Financial Analyst Lead Job Description: PBM Financial Analyst Lead This role requires associates to be in-office 1 - 2 days per week, fostering collaboration and conne…
Skills: Excel, SQL, Financial Analysis, Budgeting, Forecasting
Los Angeles, California, United States · Hybrid
$99k–$163k/yr
Anticipated End Date: 2026-07-31 Position Title: HEDIS Audit Quality Manager (State and NCQA) Job Description: HEDIS Audit Quality Manager (State and NCQA Audits) Hybrid 1: This role requires associates to be in-office 1…
Skills: HEDIS Audit Management, NCQA Guidelines, Project Management, Quantitative Analysis, Qualitative Analysis
Grand Prairie, Texas, United States · Remote OK
Anticipated End Date: 2026-08-17 Position Title: Bilingual Nurse Practitioner 100% Virtual, CareBridge Job Description: Bilingual Nurse Practitioner 100% Virtual, CareBridge $5,000 Sign-on Bonus *Seeking Bilingual Nurse …
Skills: Bilingual Communication, Complex Care Management, Telehealth, Clinical Care Planning, Patient Education
Hanover, Maryland, United States · Hybrid
$140k–$141k/yr
Anticipated End Date: 2026-08-31 Position Title: Test Data Management Advisor Senior Job Description: Test Data Management Advisor Senior Location: Ideal candidates will be able to report to our Pulse Point location at 7…
Skills: Facets, Test Data Management, Aws Cloud Migration, Oracle Sql, Edi X12 Standards
Atlanta, Georgia, United States · Hybrid
$88k–$144k/yr
Anticipated End Date: 2026-07-23 Position Title: Learning Consultant Job Description: Learning Consultant Location: This role requires associates to be in-office 1 - 2 days per week, fostering collaboration and connectiv…
Skills: Project Management, Instructional Design, Needs Analysis, Stakeholder Management, Adult Learning Theory
Atlanta, Georgia, United States · Hybrid
$115k–$207k/yr
Anticipated End Date: 2026-08-24 Position Title: Manager of DRG Coding & Clinical Validation Audit Job Description: Manager of DRG Coding Audit-Program/Project Locations: The selected candidate must reside within a reaso…
Skills: DRG Auditing, ICD-10 Coding, Clinical Validation, Project Management, Process Reengineering
Pasig, Metro Manila, Philippines · On-site
Position Title: Mgr Asst Customer Care (PHL) Shift: Job Description: Responsible for serving as the operations point of contact in for day to day operations, including but not limited to, facilitating issue resolution, m…
Skills: Operations Management, Performance Management, Staffing Coordination, Workforce Management, Coaching
Lake Mary, Florida, United States · Hybrid
$16/hr–$24/hr
Anticipated End Date: 2026-07-23 Position Title: Claims Representative I Job Description: Claims Representative I Location: This role enables associates to work virtually full-time, except for required in-person training…
Skills: Oral communication, Written communication, PC proficiency, Database systems, Word processing
Murfreesboro, Tennessee, United States · On-site
Anticipated End Date: 2026-09-04 Position Title: Registered Nurse (PRN)- Paragon Infusion Centers Job Description: Registered Nurse (PRN)- Paragon Infusion Centers Location: 1855 Medical Center Pkwy, STE G, Murfreesboro,…
Skills: IV Administration, Port Access, PICC Line Management, Peripheral Line Management, Medication Mixing
Avondale, Arizona, United States · Hybrid
Anticipated End Date: 2026-07-23 Position Title: Provider Network Manager Job Description: Provider Network Manager Location: Arizona Position Territory: Ideal candidates will be based in Arizona and willing to travel th…
Skills: Contract Negotiation, Provider Relations, Provider Servicing, Financial Projections, Financial Analysis
Indianapolis, Indiana, United States · Hybrid
Anticipated End Date: 2026-07-23 Position Title: Nurse Case Manager Lead Job Description: Telephonic Nurse Case Manager Lead Sign on Bonus: $3000. Location: This role enables associates to work virtually full-time, with …
Skills: Care Management, Clinical Assessment, Discharge Planning, Case Management, Conflict Resolution
Quinte West, Ontario, Canada · Hybrid
$96k–$166k/yr
Anticipated End Date: 2026-07-23 Position Title: Business Consultant Sr Job Description: Business Consultant Sr Location: Woodland Hills CA, Nashville TN, Atlanta GA, Norfolk VA, Las Vegas NV, Denver CO, St. Louis MO Hou…
Skills: Business Analysis, Project Management, Agile Methodology, Requirement Gathering, Stakeholder Management
Lake Mary, Florida, United States · Hybrid
Anticipated End Date: 2026-07-23 Position Title: CarelonRx Sales Support Specialist Senior Job Description: Sales Support Specialist Senior Location: This role requires associates to be in-office 1 - 2 days per week, fos…
Skills: Administrative Support, Patient Benefit Investigation, Prior Authorization, CRM Management, EMR Documentation
Las Vegas, Nevada, United States · Remote OK
$73k–$109k/yr
Anticipated End Date: 2026-07-27 Position Title: Behavioral Health Case Manager II Job Description: Behavioral Health Case Manager II Join Carelon's growing Behavioral Health Community Connect team supporting the Health …
Skills: Behavioral Health Assessment, Care Planning, Case Management, Telephonic Coaching, Motivational Interviewing
Las Vegas, Nevada, United States · Remote OK
$73k–$109k/yr
Anticipated End Date: 2026-07-27 Position Title: Behavioral Health Case Manager II Job Description: Behavioral Health Case Manager II Join Carelon's growing Behavioral Health Community Connect team supporting the Health …
Skills: Behavioral Health Assessment, Care Planning, Case Management, Telephonic Coaching, Motivational Interviewing
Miami, Florida, United States · Remote OK
Anticipated End Date: 2026-08-28 Position Title: Pharmacy Technician II – Clinical Pharmacy Care Center Job Description: Pharmacy Technician II – Clinical Pharmacy Care Center Virtual: This role enables associates to wor…
Skills: Prescription Data Entry, Prior Authorization Processing, Adjudication Troubleshooting, Member Education, Care Gap Closure
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The Nurse Case Manager I performs care management for members with complex and chronic needs by developing and monitoring personalized care plans. This role involves coordinating internal and external resources and conducting assessments both telephonically and on-site to reduce hospital readmissions.
Requires a BA/BS in a health-related field and at least 3 years of clinical experience. A current, unrestricted RN license in the state of Texas is mandatory.
Location: The ideal candidate would reside within the state of Texas.
Field: This field-based role enables associates to primarily operate in the field, traveling to client sites or designated locations as their role requires, with occasional office attendance for meetings or training. This approach ensures flexibility, responsiveness to client needs, and direct, hands-on engagement.
Please note that per our policy on hybrid/virtual work, candidates not within a reasonable commuting distance from the posting location(s) will not be considered for employment, unless accommodation is granted as required by law.
Carelon, a proud member of the Elevance Health family of companies, is a healthcare services organization that takes a whole-health approach to making care more integrated, personalized, and affordable. We put people at the center—connecting physical, behavioral, social, and pharmacy services, along with clinical expertise, research, operations, and advanced technology to help care work better, together.
Among us are specialty-care physicians, nurse practitioners, pharmacists, engineers, data scientists, and other dedicated and caring health professionals. While our roles may differ, our purpose is shared: to make a positive impact on whole health.
The Nurse Case Manager I will be 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 or on-site such as at hospitals, member's home, or clinics for assistance with decreasing hospital/ER readmission. The Nurse Case Manager will be in the field 2x-3x a week based on business needs.
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 referrals as appropriate within benefits structure or through state 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.
Assists in problem solving with providers, claims or service issues.
Minimum Requirements:
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 within the state of Texas is required.
Multi-state licensure is required if this individual is providing services in multiple states.
Certification as a Case Manager is preferred.
Experience with Microsoft TEAMs, Outlook, Word, and Excel.
Experience with Home Health completing field visits.
Experience with Medicaid.
Positive, strong interpersonal and communication skills.
Please be advised that Elevance Health only accepts resumes for compensation from agencies that have a signed agreement with Elevance Health. Any unsolicited resumes, including those submitted to hiring managers, are deemed to be the property of Elevance Health.
Elevance Health is a health company dedicated to improving lives and communities – and making healthcare simpler. We are a Fortune 25 company with a longstanding history in the healthcare industry, looking for leaders at all levels of the organization who are passionate about making an impact on our members and the communities we serve.
At Elevance Health, we are creating a culture that is designed to advance our strategy but will also lead to personal and professional growth for our associates. Our values and behaviors are the root of our culture. They are how we achieve our strategy, power our business outcomes and drive our shared success - for our consumers, our associates, our communities and our business.
We offer a range of market-competitive total rewards that include merit increases, paid holidays, Paid Time Off, and 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 and financial education resources, to name a few.
Elevance Health operates in a Hybrid Workforce Strategy. Unless specified as primarily virtual by the hiring manager, associates are required to work at an Elevance Health location at least once per week, and potentially several times per week. Specific requirements and expectations for time onsite will be discussed as part of the hiring process.
The health of our associates and communities is a top priority for Elevance Health. We require all new candidates in certain patient/member-facing roles to become vaccinated against COVID-19 and Influenza. If you are not vaccinated, your offer will be rescinded unless you provide an acceptable explanation. Elevance Health will also follow all relevant federal, state and local laws.
Elevance Health is an Equal Employment Opportunity employer, and all qualified applicants will receive consideration for employment without regard to age, citizenship status, color, creed, disability, ethnicity, genetic information, gender (including gender identity and gender expression), marital status, national origin, race, religion, sex, sexual orientation, veteran status or any other status or condition protected by applicable federal, state, or local laws. Applicants who require accommodation to participate in the job application process should submit the following form: Accessibility Accommodation Request Form and a member of the team will be in contact. Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state, and local laws, including, but not limited to, the Los Angeles County Fair Chance Ordinance and the California Fair Chance Act.
Prospective employees required to be screened under Florida law should review the education and awareness resources at HB531 | Florida Agency for Health Care Administration.
NOTE: Workday keeps job postings active through 11:59:59 PM on the day before the listed end date. Example: If the end date is 3/13, the posting will automatically come down on 3/12 at 11:59:59 PM. In other words — the job is posted until 3/13, not through 3/13.
Fueled by our bold purpose to improve the health of humanity, we are transforming from a traditional health benefits organization into a lifetime trusted health partner. Our nearly 100,000 associates serve more than 118 million people, at every stage of health. We address a full range of needs with an integrated whole health approach, powered by industry-leading capabilities and a digital platform for health. We believe that improving health for everyone is possible. It begins by redefining health, reimagining the health system, and strengthening our communities.
Offices: 220 Virginia Ave, Indianapolis, Indiana 46204, US
Fueled by our bold purpose to improve the health of humanity, we are transforming from a traditional health benefits organization into a lifetime trusted health partner. Our nearly 100,000 associates serve more than 118 million people, at every stage of health. We address a full range of needs with an integrated whole health approach, powered by industry-leading capabilities and a digital platform for health. We believe that improving health for everyone is possible. It begins by redefining health, reimagining the health system, and strengthening our communities.
Offices: 220 Virginia Ave, Indianapolis, Indiana 46204, US
