Maternal-Child RN Case Manager (Remote)

Elevance Health; Grand Prairie (TX); On-site; USD 70,000 - 90,000; Full time

Job summary

Elevance Health is seeking a Maternal Child Nurse Case Manager I to perform care management for members with complex and chronic care needs, 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.

The role supports hybrid/virtual work with in-person training sessions, and ensures compliance with commuting

Qualifications

• Requires BA/BS in a health related field and minimum of 3 years of clinical experience; or any combination of education and experience providing equivalent background.
• Current, unrestricted RN license in applicable state(s) required.
• Multi-state licensure required if providing services in multiple states.
• Current and active RN license required in applicable state(s).

Responsibilities

• 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.

Skills

RN licensure

Clinical experience

Care management

Education

BA/BS in health-related field

Job description

Elevance Health is seeking a Maternal Child Nurse Case Manager I to perform care management for members with complex and chronic care needs, 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.

The role supports hybrid/virtual work with in-person training sessions, and ensures compliance with commuting