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Nurse Case Manager l - Medicaid / CalAIM Special Programs


  • CA, Woodland Hills
  • CA, Cerritos
  • CA, San Francisco
  • CA, Costa Mesa



Nurse Case Manager l – CalAIM Special Programs 

Location:  This is a work@home position, 100% telephonic. You must reside in the state of California.

Work Hours:  8am – 5pm, Monday – Friday PST

How you will make an impact:

The  Nurse Case Manager l for Special Programs  is responsible for collaborating with healthcare providers, community-based organizations, and members to promote quality member outcomes; to optimize member benefits; and to promote effective use of resources related to Enhanced Care Management, medical nutrition therapy, and other SDoH projects. This position will also support the implementation of the Enhanced Care Management as new benefit where the Case Manager partners with external Interdisciplinary Teams and acts as a direct liaison to external providers and coordinates specific health services to address objectives and goals identified during assessment and care planning activities. He/ she performs care management/coordination activities within the scope of licensure for members served through these programs, and partners with physician clinical reviewers and/or medical directors to interpret appropriateness of care, intervention planning, and general clinical guidance.

Primary duties may include, but are not limited to:

  • Works with external providers/case managers to implement and coordinate care plans specific to Enhanced Care Management, and palliative care; monitors and evaluates effectiveness of the care management plan and modifies as necessary.
  • Ensures an assessment is completed and a health service plan is developed that is person centric in establishing goals and objectives aimed at preventing adverse health episodes and maintaining/ promoting health of members.
  • Works with external partners to ensure member access to medically necessary, quality healthcare in a cost-effective setting.
  • Acts as a direct liaison to external care teams and assists with implementation of care plans by coordinating internal resources to meet member needs, and by facilitating authorizations/referrals appropriate within the benefits structure.
  • Consults with clinical reviewers and/or medical directors to ensure medically appropriate, high quality, cost effective care throughout the medical management process.
  • Facilitates member care transitions through the healthcare continuum and refers treatment plans/plan of care to clinical reviewers as required.
  • Collaborates with providers to assess consumer needs for early identification of and proactive planning for discharge.
  • Conducts care coordination reviews to ensure compliance with applicable criteria, medical policy, and member eligibility and benefits.
  • Advocates with healthcare providers on behalf of members.
  • Performs duties telephonically.


Minimum Requirements:

  • Requires BA/BS in a health related field  and three years of either acute care clinical, condition specific clinical, home health/discharge planning, case management, or disease management experience; at least 1 year in a Nurse Care Manager role; or any combination of education and experience which would provide an equivalent background.
  • Current, unrestricted RN license in California.
  • Must reside in the state of California.
  • Must be able to work 8am – 5pm, Monday – Friday.

Preferred Qualifications:

  • Prior experience in a role where coordination of specific needs and challenges of high-risk populations were part of the job responsibilities, i.e. Homeless, High Utilizers, SMI/SUD, Nursing Facility transition to community, LTC at risk for institutionalization; Incarcerated transition to community, and high-risk children and youth is strongly preferred
  • Experience in working with the Medi-Cal population, including but not limited to seniors, persons with mental or physical disabilities, individuals with chronic medical conditions, or individuals who are homeless.
  • Knowledge of medical management process and ability to interpret and apply member contracts, member benefits, and managed care products.
  • PC skills (Word, Excel, Outlook).
  • Experience in program implementation of community-based services.

Please be advised that Elevance Health only accepts resumes from agencies that have a signed agreement with Elevance Health. Accordingly, Elevance Health is not obligated to pay referral fees to any agency that is not a party to an agreement with Elevance Health. Thus, any unsolicited resumes, including those submitted to hiring managers, are deemed to be the property of Elevance Health.

Be part of an Extraordinary Team

Elevance Health is a health company dedicated to improving lives and communities – and making healthcare simpler. Previously known as Anthem, Inc., we have evolved into a company focused on whole health and updated our name to better reflect the direction the company is heading.

We are looking for leaders at all levels of the organization who are passionate about making an impact on our members and the communities we serve. You will thrive in a complex and collaborative environment where you take action and ownership to solve problems and lead change. Do you want to be part of a larger purpose and an evolving, high-performance culture that empowers you to make an impact?

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.

The health of our associates and communities is a top priority for Elevance Health. We require all new candidates to become vaccinated against COVID-19. If you are not vaccinated, your offer will be rescinded unless you provide – and Elevance Health approves – a valid religious or medical explanation as to why you are not able to get vaccinated that Elevance Health is able to reasonably accommodate. Elevance Health will also follow all relevant federal, state and local laws.

Elevance Health has been named as a Fortune Great Place To Work in 2021, is ranked as one of the 2021 World’s Most Admired Companies among health insurers by Fortune magazine, and a Top 20 Fortune 500 Companies on Diversity and Inclusion. To learn more about our company and apply, please visit us at 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 may contact for assistance.

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