Pediatric Nurse Case Mgr I

Elevance Health•Lake Mary, FL

1d•Onsite

About The Position

This Field Based position will be required to visit members in person within Orlando, FL. This field-based role enables associates to primarily operate in the field, traveling to client sites or designated locations as their role requires, with occasional office attendance for meetings or training. This approach ensures flexibility, responsiveness to client needs, and direct, hands-on engagement. Alternate locations may be considered if candidates reside within a commuting distance from an office. The Pediatric Nurse Case Mgr I is responsible for performing care management within the scope of licensure for members with complex and chronic care needs by assessing, developing, implementing, coordinating, monitoring, and evaluating care plans designed to optimize member health care across the care continuum. Performs duties telephonically or on-site such as at hospitals for discharge planning.

Requirements

Requires BA/BS in a health related field and minimum of 3 years of pediatric clinical experience ; or any combination of education and experience, which would provide an equivalent background.
Current, unrestricted RN license in the state of Florida is required.

Nice To Haves

Bilingual communication skills in Spanish and English strongly preferred.
Certification as a Case Manager preferred.
Computer savvy.

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 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.