Remote OB/NICU/Peds Nurse Case Manager I

Elevance Health; Winston-Salem (NC); Hybrid; USD 70,000 - 95,000; Full time

Job summary

Elevance Health in North Carolina seeks a Nurse Case Manager I to perform care management telephonically for members with complex and chronic needs, within licensure scope. Requires NC RN license and 3+ years clinical experience, with multi-state licensure if needed.

Virtual full-time with in-person training and hybrid onsite requirements. role emphasizes assessments, care planning, authorizations, coordination of care, and collaboration with medical directors to optimize health outcomes and

Qualifications

• Requires BA/BS in a health related field.
• Current, unrestricted RN license in applicable state(s) required.
• Multi-state licensure is required if providing services in multiple states.
• Certification as a Case Manager is preferred.

Responsibilities

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

Skills

Care management

RN licensure

Multistate licensure

Telephonic care

Education

BA/BS in a health related field

Job description

Elevance Health in North Carolina seeks a Nurse Case Manager I to perform care management telephonically for members with complex and chronic needs, within licensure scope. Requires NC RN license and 3+ years clinical experience, with multi-state licensure if needed.

Virtual full-time with in-person training and hybrid onsite requirements. role emphasizes assessments, care planning, authorizations, coordination of care, and collaboration with medical directors to optimize health outcomes and