Remote OB/NICU/Peds RN Case Manager I

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

Benefits offered by this job

Merit increases

Paid holidays

Paid Time Off

Incentive bonuses

Medical insurance

Dental insurance

Vision insurance

401(k) matching

Stock purchase plan

Life insurance

Wellness programs

Financial education

Job summary

Elevance Health in North Carolina is seeking an OB/NICU/PEDs Nurse Case Manager I to perform telephonic care management for members with complex chronic needs. Requires RN license in NC and a BA/BS in a health field with 3 years of clinical experience; hybrid/virtual work with in-person training sessions.

Responsibilities include assessments, care plan development, care coordination, and interfacing with Medical Directors. Multistate licensure may be required; vaccination policy Applies.

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.

Responsibilities

• Ensures member access to services appropriate to their health needs.
• Conducts assessments to identify 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 license

Clinical experience

Case management

Multistate licensure

Education

BA/BS in health field

Job description

Elevance Health in North Carolina is seeking an OB/NICU/PEDs Nurse Case Manager I to perform telephonic care management for members with complex chronic needs. Requires RN license in NC and a BA/BS in a health field with 3 years of clinical experience; hybrid/virtual work with in-person training sessions.

Responsibilities include assessments, care plan development, care coordination, and interfacing with Medical Directors. Multistate licensure may be required; vaccination policy Applies.