Field-Based Pediatric Nurse Case Manager I

Elevance Health (Anthem)

Florida

Hybrid

USD 65,000 - 80,000

Full time

6 days ago

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Job summary

Elevance Health in Orlando is seeking a Pediatric Nurse Case Manager I to perform care management for members with complex needs, both telephonically and on-site. The role is field-based with occasional office attendance, requiring travel to member sites within Orlando, FL.

The position emphasizes assessing, developing, implementing, coordinating and monitoring care plans to optimize health outcomes. A valid Florida RN license is required, with a BA/BS in a health-related field and at least 3

Qualifications

Requires BA/BS in a health-related field and minimum of 3 years of pediatric clinical experience.
Current, unrestricted RN license in the state of Florida is required.
Bilingual communication skills in Spanish and English strongly preferred; Certification as a Case Manager preferred; Computer savvy.

Responsibilities

Ensures member access to services appropriate to health needs.
Conducts assessments to identify individual needs and a care management plan to address objectives and goals.
Implements care plan by facilitating authorizations/referrals 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 care management plans.
Negotiates rates of reimbursement, as applicable.
Assists in problem solving with providers, claims or service issues.