Elevance Healthposted 6 months ago
Full-time - Mid Level
Remote - Louisville, KY
Insurance Carriers and Related Activities
About the position
The Telephonic NICU Nurse Case Manager II is a virtual role focused on managing NICU cases for members. This position involves assessing, developing, implementing, coordinating, monitoring, and evaluating care plans to optimize healthcare across the continuum. The role requires telephonic communication to ensure members have access to appropriate services and resources.
Responsibilities
- Ensure member access to services appropriate to their health needs.
- Conduct assessments to identify individual needs and develop specific care management plans.
- Implement care plans by facilitating authorizations/referrals as appropriate.
- Coordinate internal and external resources to meet identified needs.
- Monitor and evaluate the effectiveness of care management plans and modify as necessary.
- Interface with Medical Directors and Physician Advisors on care management treatment plans.
- Negotiate rates of reimbursement as applicable.
- Assist in problem solving with providers, claims, or service issues.
- Assist with the development of utilization/care management policies and procedures.
Requirements
- Registered Nurse (RN) license in the state of Kentucky.
- Experience in NICU nursing or case management.
- Strong communication and interpersonal skills.
- Ability to work independently in a virtual environment.
Nice-to-haves
- Certification in case management (CCM) or similar credentials.
- Experience with telephonic case management.
Benefits
- Work from home option.
- Flexible working hours after initial training period.
