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 is responsible for performing care management within the scope of licensure for members with complex and chronic care needs. This 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.

In this virtual role, candidates must reside within the state of Indiana. Associates work full-time virtually except for required in-person training sessions, promoting productivity and work-life integration. The position operates Monday through Friday from 8:00am to 5:00pm EST.

Daily responsibilities include ensuring member access to appropriate services, conducting assessments to identify needs, and implementing care plans through authorizations or referrals. Coordination of internal and external resources occurs alongside monitoring plan effectiveness and interfacing with Medical Directors on treatment plans.

This non-management exempt role within the MED > Licensed Nurse job family offers opportunities to negotiate reimbursement rates and assist with provider or claims issues. It supports independent work in a managed care environment focused on OB/NICU specialties.

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
Managed Care experience preferred
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 develops 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