Pediatric RN Nurse Case Manager Sr.

Requirements

• Experience in Pediatrics is very strongly preferred.
• Certification as a Case Manager is preferred.
• For candidates working in person or virtual in the below location(s), the salary* range for this specific position is $91,724 - $ 137,586
• Locations: District of Columbia (Washington, DC)
• The salary range is the range Elevance Health in good faith believes is the range of possible compensation for this role at the time of this posting. This range may be modified in the future and actual compensation may vary from posting based on geographic location, work experience, education and/or skill level. Even within the range, the actual compensation will vary depending on the above factors as well as market/business considerations. No amount is considered to be wages or compensation until such amount is earned, vested, and determinable under the terms and conditions of the applicable policies and plans. The amount and availability of any bonus, commission, benefits, or any other form of compensation and benefits that are allocable to a particular employee remains in the Company's sole discretion unless and until paid and may be modified at the Company's sole discretion, consistent with the law.
• Job Level:
• Non-Management Exempt
• Workshift:
• 1st Shift (United States of America)
• Job Family:
• MED > Licensed Nurse
• Please be advised that Elevance Health only accepts resumes for compensation from agencies that have a signed agreement with Elevance Healt

Benefits

Additional Information

Anticipated End Date: 2026-06-25 Position Title: Pediatric RN Nurse Case Manager Sr. Job Description: Nurse Case Manager Sr. LOCATION : Washington D.C. in-office 4 days per week. You must be within a commutable distance of this location. HOURS : General business hours, Monday through Friday. Hybrid 2: This role requires associates to be in-office 4 days per week, fostering collaboration and connectivity, while providing flexibility to support productivity and work-life balance. This approach combines structured office engagement with the autonomy of virtual work, promoting a dynamic and adaptable workplace. 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 an accommodation is granted as required by law. The Pediatric Nurse Case Manager Sr will be responsible for 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 for discharge planning. Primary responsibilities include, but are not limited to : 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 authorizations/referrals as appropriate within benefits structure or through extra-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. Negotiates rates of reimbursement, as applicable. Assists in problem solving with providers, claims or service issues. Assists with development of utilization/care management policies and procedures, chairs and schedules meetings, as well as presents cases for discussion at Grand Rounds/Care Conferences and participates in interdepartmental and/or cross brand workgroups. May require the development of a focused skill set including comprehensive knowledge of specific disease process or traumatic injury and functions as preceptor for new care management staff. Participates in department audit activities. Required Qualifications Requires 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 from the state which you reside is required. Multi-state licensure is required if this individual is providing services in multiple states.

Your Match

How well this role fits your profile.

Company Intel

What employees say

Worked at Elevance Health (Anthem)? Share your experience