[Hiring] OB/NICU Nurse Case Manager I @Elevance Health

Role Description

The OB/NICU Nurse Case Manager I is 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.
• Performing duties telephonically or on-site such as at hospitals for discharge planning.

How you will make an impact:

• 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.

Qualifications

• 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 in applicable state(s) required.
• Multi-state licensure is required if this individual is providing services in multiple states.
• For URAC accredited areas: Requires BA/BS and 3 years of clinical care experience; or any combination of education and experience, which would provide an equivalent background.
• Current and active RN license required in applicable state(s).
• Multi-state licensure is required if this individual is providing services in multiple states.

Requirements

• Case Manager experience preferred.
• Spanish Bilingual Preferred.
• Certification as a Case Manager and a BS in a health or human services related field preferred.
• OB and/or NICU experience preferred.
• Managed Care experience preferred.
• Ability to talk and type at the same time.
• Strong computer skills (including Microsoft Office) and/or ability to learn new computer programs/systems/software quickly.
• Ability to manage, review and respond to emails/instant messages in a timely fashion.
• Strong organization and time management skills with the ability to work independently.

Benefits

• Merit increases.
• Paid holidays.
• Paid Time Off.
• Incentive bonus programs (unless covered by a collective bargaining agreement).
• Medical, dental, vision benefits.
• Short and long term disability benefits.
• 401(k) + match.
• Stock purchase plan.
• Life insurance.
• Wellness programs.
• Financial education resources.