RN Nurse Case Manager I (Pediatrics) at Elevance Health in Hanover, Maryland

Job Description:

LOCATION: This is a remote opportunity and you must be within 50 miles of our Hanover, Maryland office. Maryland residency is required.




HOURS: General business hours, Monday through Friday: 8:30 am - 5:30 pm




TRAVEL: Occasional visits to the office may be required for team meetings or training.



The Nurse Case Manager I (Pediatrics) is responsible for performing care management within the scope of licensure for youngest members with complex and chronic care. They are responsible for those members at highest risk for a rapid readmission, thus promptly engaging them to assess and address red flags, improve the quality of care, and allow for real-time oversight. Performs duties telephonically.


Primary duties may include, but are not limited to:

• 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.
  
  

Required 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 from the state of Maryland is required.
  
  

Preferred Qualifications

• Previous dedicated pediatric/high-risk pediatric nursing experience is must for this role!
  
  


• Previous experience as a case manager is strongly preferred.
  
  


• Previous Medicaid and/or Managed Care experience is very helpful.
  
  

Please be advised that Elevance Health only accepts resumes for compensation from agencies that have a signed agreement with Elevance Health. Any unsolicited resumes, including those submitted to hiring managers, are deemed to be the property of Elevance Health.

Who We Are

Elevance Health is a health company dedicated to improving lives and communities - and making healthcare simpler. We are a Fortune 25 company with a longstanding history in the healthcare industry, looking for leaders at all levels of the organization who are passionate about making an impact on our members and the communities we serve.

How We Work

At Elevance Health, we are creating a culture that is designed to advance our strategy but will also lead to personal and professional growth for our associates. Our values and behaviors are the root of our culture. They are how we achieve our strategy, power our business outcomes and drive our shared success - for our consumers, our associates, our communities and our business.

We offer a range of market-competitive total rewards that include merit increases, paid holidays, Paid Time Off, and incentive bonus programs (unless covered by a collective bargaining agreement), medical, dental, vision, short and long term disability benefits, 401(k) +match, stock purchase plan, life insurance, wellness programs and financial education resources, to name a few.

Elevance Health operates in a Hybrid Workforce Strategy. Unless specified as primarily virtual by the hiring manager, associates are required to work at an Elevance Health location at least once per week, and potentially several times per week. Specific requirements and expectations for time onsite will be discussed as part of the hiring process. Candidates must reside within 50 miles or 1-hour commute each way of a relevant Elevance Health location.

The health of our associates and communities is a top priority for Elevance Health. We require all new candidates in certain patient/member-facing roles to become vaccinated against COVID-19. If you are not vaccinated, your offer will be rescinded unless you provide an acceptable explanation. Elevance Health will also follow all relevant federal, state and local laws.

Elevance Health is an Equal Employment Opportunity employer and all qualified applicants will receive consideration for employment without regard to age, citizenship status, color, creed, disability, ethnicity, genetic information, gender (including gender identity and gender expression), marital status, national origin, race, religion, sex, sexual orientation, veteran status or any other status or condition protected by applicable federal, state, or local laws. Applicants who require accommodation to participate in the job application process may contact elevancehealthjobssupport@elevancehealth.com for assistance. Apply Now