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 (Obstetrics & Pediatrics) is responsible for performing care management within the scope of licensure for our 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 high-risk obstetrics and 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.
For candidates working in person or remotely in the below location(s), the salary* range for this specific position is $67,116 - $100,674
Location(s): Maryland
In addition to your salary, Elevance Health offers benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). The salary offered for this specific position is based on a number of legitimate, non-discriminatory factors set by the Company. The Company is fully committed to ensuring equal pay opportunities for equal work regardless of gender, race, or any other category protected by federal, state, and local pay equity laws.
* The salary range is the range Elevance Health in good faith believes is the range of possible compensation for this role at the time of this posting. This range may be modified in the future and actual compensation may vary from posting based on geographic location, work experience, education and/or skill level. Even within the range, the actual compensation will vary depending on the above factors as well as market/business considerations. No amount is considered to be wages or compensation until such amount is earned, vested, and determinable under the terms and conditions of the applicable policies and plans. The amount and availability of any bonus, commission, benefits, or any other form of compensation and benefits that are allocable to a particular employee remains in the Company's sole discretion unless and until paid and may be modified at the Company's sole discretion, consistent with the law.
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