About this role
The Telephonic NICU Nurse Case Manager II is responsible for care management within the scope of licensure for members with complex and chronic care needs. This role involves assessing, developing, implementing, coordinating, monitoring, and evaluating care plans designed to optimize member health care across the care continuum. Duties are performed telephonically or on-site such as at hospitals for discharge planning.
Daily responsibilities include ensuring member access to appropriate services, conducting assessments to identify needs, and implementing care plans by facilitating authorizations/referrals within benefits or extra-contractual arrangements. Coordinates internal and external resources, monitors plan effectiveness, and modifies as necessary. Interfaces with Medical Directors and Physician Advisors on treatment plans.
This virtual role offers Monday-Friday shifts from 8:00am-4:30pm EST, enabling full-time remote work except for required in-person training sessions. It services members in different states, requiring multi-state licensure. Alternate locations may be considered if within commuting distance from an office.
Assists in problem solving with providers, negotiates reimbursement rates, and contributes to utilization/care management policies. Promotes productivity, work-life integration, and skill development through flexible virtual setup. Delivers high-impact care coordination for NICU-focused cases.
Requirements
- BA/BS in a health related field and minimum of 5 years of clinical experience; or equivalent
- Current, unrestricted RN license in applicable state(s)
- Multi-state licensure required
- NICU experience strongly preferred
- Certification as a Case Manager
- Managed Care experience
- Ability to talk and type at the same time
- Demonstrate critical thinking skills when interacting with members
Responsibilities
- Ensures member access to services appropriate to their health needs
- Conducts assessments to identify individual needs and specific 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
Benefits
- Salary range of $79,464 to $124,872 for Illinois and New York
- Work virtually full-time with exception of required in-person training
- Maximum flexibility and autonomy promoting productivity and work-life integration
- Comprehensive benefits
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