OB/NICU/Peds Nurse Case Manager I - Remote

Elevance Health; North Carolina; Hybrid; USD 65,000 - 90,000; Full time

Job summary

Elevance Health is seeking an OB/NICU/PEDs Nurse Case Manager I to perform care management for members with complex and chronic needs, primarily via telephonic engagement. The role requires an RN licensed in North Carolina and supports hybrid work with in-person training sessions.

Responsibilities include assessments, developing and coordinating care plans, facilitating authorizations, coordinating resources, and monitoring outcomes to optimize member health care across the care continuum.

Qualifications

• Requires BA/BS in a health related field and minimum of 3 years of clinical experience.
• Current, unrestricted RN license in North Carolina.
• Multi-state licensure is required if this individual is providing services in multiple states.

Responsibilities

• Ensures member access to services appropriate to their health needs.
• Conducts assessments to identify individual needs and a care management plan.
• 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 license

Case management

Telephonic care

NC licensure

Education

BA/BS in health-related field

Tools

Case Manager certification

Job description

Elevance Health is seeking an OB/NICU/PEDs Nurse Case Manager I to perform care management for members with complex and chronic needs, primarily via telephonic engagement. The role requires an RN licensed in North Carolina and supports hybrid work with in-person training sessions.

Responsibilities include assessments, developing and coordinating care plans, facilitating authorizations, coordinating resources, and monitoring outcomes to optimize member health care across the care continuum.