Telephonic NICU Nurse Case Manager I

1w1 week ago

Elevance Health

Latham, US · Full-time · $68,880 – $103,320

About this role

The Telephonic NICU Nurse Case Manager I manages NICU case management telephonically. Responsibilities include assessing, developing, implementing, coordinating, monitoring, and evaluating care plans to optimize member health across the care continuum. This virtual full-time role offers flexibility except for required in-person training sessions.

Daily duties focus on ensuring member access to appropriate health services. Conduct assessments to identify needs and create specific care management plans with objectives and goals. Facilitate authorizations, referrals, and coordinate internal and external resources within benefits structures.

Monitor and evaluate care plan effectiveness, modifying as necessary. Interface with Medical Directors and Physician Advisors on treatment plans. Assist in problem-solving with providers, claims, or service issues during Monday-Friday 8:00 am to 4:30 pm EST hours.

Contribute to developing utilization and care management policies and procedures. Ideal candidates reside within commuting distance of Latham, NY, for onboarding and skill development. Gain exposure to managed care while applying NICU expertise in a supportive environment.

Requirements

BA/BS in a health-related field and a 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 is required if providing services in multiple states
Certification as a Case Manager is preferred
Managed Care experience preferred
Clinical experience with NICU or PICU care is preferred
Knowledge of health insurance/benefits, medical management process, care management, and utilization review management
Ability to talk and type at the same time and 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 a specific care management plan to address objectives and goals
Implements care plan by facilitating authorizations/referrals as appropriate within a benefits structure
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
Assists in problem-solving with providers, claims, or service issues
Assists with development of utilization/care management policies and procedures

Benefits

Salary range of $68,880 to $103,320 for New York locations
Incentive and recognition programs
Equity stock purchase
401k contribution (all benefits subject to eligibility requirements)
Virtual full-time work with maximum flexibility and autonomy except for in-person training