Telephonic NICU Nurse Case Manager I
About The Position
Telephonic NICU Nurse Case Manager I Location: This role enables associates to work virtually full-time, with the exception of required in-person training sessions, providing maximum flexibility and autonomy. This approach promotes productivity, supports work-life integration, and ensures essential face-to-face onboarding and skill development. Please note that per our policy on virtual work, candidates not within a reasonable commuting distance from the posting location(s) will not be considered for employment, unless an accommodation is granted as required by law. The ideal candidate must reside within a commutable distance of the Latham, NY Elevance Health Pulse Point location. Hours: Monday - Friday 8:00 am to 4:30 pm EST. May be able to start at a later time if desired but cannot start earlier than 8 am EST. The Telephonic NICU Nurse Case Manager I is responsible for the NICU Case Management. Assess, develop, implement, coordinate, monitor, and evaluate care plans designed to optimize member health care across the care continuum. Performs duties telephonically.
Requirements
- Requires 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) required.
- Multi-state licensure is required if this individual is providing services in multiple states
Nice To Haves
- Certification as a Case Manager is preferred.
- Managed Care experience preferred.
- Ability to talk and type at the same time.
- Demonstrate critical thinking skills when interacting with members.
- Experience with (Microsoft Office) and/or ability to learn new computer programs/systems/software quickly.
- Ability to manage, review, and respond to emails/instant messages in a timely fashion.
- Knowledge of health insurance/benefits, medical management process, care management, and utilization review management is strongly preferred.
- Clinical experience with NICU or PICU care is preferred.
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 an assessment.
- Implements care plan by facilitating authorizations/referrals as appropriate within a 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.
- Assists in problem-solving with providers, claims, or service issues.
- Assists with development of utilization/care management policies and procedures.
Benefits
- 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).
- 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.
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
Industry
Insurance Carriers and Related Activities
Number of Employees
5,001-10,000 employees
