Remote OB/NICU/Peds Nurse Case Manager RN

Elevance Health; Greensboro (NC); Hybrid; USD 75,000 - 95,000; Full time

Job summary

Elevance Health in North Carolina is seeking an OB/NICU/PEDs Nurse Case Manager I who performs care management within licensure, assessing, developing, implementing, coordinating, monitoring and evaluating care plans for members with complex needs. Duties are conducted telephonically with occasional in-person training and periodic on-site work as required by policy.

The role requires a BA/BS in a health-related field with at least 3 years of clinical experience and an unrestricted RN license in

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.
• 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 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.

Education

BA/BS in health-related field

RN license

Job description

Elevance Health in North Carolina is seeking an OB/NICU/PEDs Nurse Case Manager I who performs care management within licensure, assessing, developing, implementing, coordinating, monitoring and evaluating care plans for members with complex needs. Duties are conducted telephonically with occasional in-person training and periodic on-site work as required by policy.

The role requires a BA/BS in a health-related field with at least 3 years of clinical experience and an unrestricted RN license in