Job ID: JP00046780
Anticipated Start Date: 9/01/2026
Responsible for collaborating with healthcare providers and/or consumer to drive personalized health management and improve health outcomes for optimal consumers. Serves as a team lead for nursing staff that collaborate with healthcare providers and members.
Performs care management activities within the scope of licensure for members with complex and chronic care needs.
Primary duties may include, but are not limited to:
Maintains an active case load of the most complex cases and assists team members in the delivery of disease management programs; provides guidance and assistance with clinical, program, and client specific questions and situations.
Ensures medically appropriate, high quality, cost effective care through assessing the medical necessity of inpatient admissions, outpatient services, out of network services, and appropriateness of treatment setting and level of care.
Serves as resource to lower-level nurses; functions as preceptor for new care management staff.
Serves as first line contact for conflict resolution.
Develops training materials, completes quality audits, and performs process evaluations, and tests and monitors systems/process enhancements.
Assists with development of care management policies, procedures, and new programs.
Monitors assigned telephone skill groups and work volumes to meet performance expectations as related to call volume, call length, and productivity. Identifies potential obstacles and reports possible solutions.
Requirements:
Requires a HS diploma or equivalent and a minimum of 7 years of acute care clinical experience and minimum of 2 years of disease management experience, home health/discharge planning experience, managed care experience and leadership experience and minimum of 2 years in Nurse Care Mgr II role or minimum of 1 year in Nurse Care Mgr Sr role or equivalent experience; or any combination of education and experience, which would provide an equivalent background.
Current, valid active unrestricted RN license in applicable state(s) required.
Must reside within a 50-mile radius of a PulsePoint location.
Preferred:
Multi-state licensure is required if this individual is providing services in multiple states. AS or BS in nursing preferred.
Certification as a Case Manager is preferred.
Certification in the American Association of Managed Care Nurses preferred.
Broad clinical knowledge base of disease processes strongly preferred.
Prior case management experience preferred.
Knowledge of medical management process and ability to interpret and apply member contracts, member benefits, and managed care products strongly preferred.
Job Type:
Contract
Additional Details:
Work Schedule Monday- Friday 8a-5p (local time)
Elevance Health operates in a Hybrid Workforce Strategy. Unless specified as primarily virtual by the hiring manager, contractors 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.
About BCForward:
Founded in 1998 on the idea that industry leaders needed a professional service, and workforce management expert, to fuel the development and execution of core business and technology strategies, BCforward is a Black-owned firm providing unique solutions supporting value capture and digital product delivery needs for organizations around the world. Headquartered in Indianapolis, IN with an Offshore Development Center in Hyderabad, India, BCforward’s 6,000 consultants support more than 225 clients globally.
BCforward champions the power of human potential to help companies transform, accelerate, and scale. Guided by our core values of People-Centric, Optimism, Excellence, Diversity, and Accountability, our professionals have helped our clients achieve their strategic goals for more than 25 years. Our strong culture and clear values have enabled BCforward to become a market leader and best in class place to work.
BCForward is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, or protected veteran status and will not be discriminated against based on disability.
To learn more about how BCforward collects and uses personal information as part of the recruiting process, view our Privacy Notice and CCPA Addendum. As part of the recruitment process, we may ask for you to disclose and provide us with various categories of personal information, including identifiers, professional information, commercial information, education information, and other related information. BCforward will only use this information to complete the recruitment process.
This posting is not an offer of employment. All applicants applying for positions in the United States must be legally authorized to work in the United States. The submission of intentionally false or fraudulent information in response to this posting may render the applicant ineligible for the position. Any subsequent offer of employment will be considered employment at-will regardless of the anticipated assignment duration.