OB/NICU Nurse Case Manager I

1w1 week ago

Elevance Health

Indianapolis, US · Full-time · $75,000 – $95,000

About this role

The OB/NICU Nurse Case Manager I performs care management within the scope of licensure for members with complex and chronic care needs. This includes assessing, developing, implementing, coordinating, monitoring, and evaluating care plans designed to optimize member health care across the care continuum. Duties occur telephonically or on-site such as at hospitals for discharge planning.

Ensures member access to services appropriate to their health needs while conducting assessments to identify individual needs and specific care management plans. Implements plans by facilitating authorizations/referrals within benefits or extra-contractual arrangements. Coordinates internal and external resources to meet identified needs.

Monitors and evaluates the effectiveness of care management plans, modifying as necessary. Interfaces with Medical Directors and Physician Advisors on treatment plans development. Performs virtually full-time from within Indiana, Monday-Friday 8:00am-5:00pm EST, except for required in-person training sessions.

This virtual approach provides maximum flexibility, autonomy, productivity, and work-life integration. Negotiates rates of reimbursement and assists in problem solving with providers, claims or service issues. Builds skills through OB/NICU focus and case management practices.

Requirements

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)
Multi-state licensure required if providing services in multiple states
Case Manager experience preferred
Certification as a Case Manager preferred
OB and/or NICU experience preferred
Ability to talk and type at the same time
Strong computer skills including Microsoft Office and ability to learn new programs quickly

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
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

Benefits

Virtual full-time work with maximum flexibility and autonomy
Exception for required in-person training sessions for onboarding and skill development
Monday – Friday 8:00am – 5:00pm EST shift
Supports work-life integration and productivity