About the role

  • Performs 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.
  • 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.
  • Assists in problem solving with providers, claims or service issues.

Requirements

  • Requires BA/BS in a health related field and minimum of 3 years of relative 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.
  • Case Management experience is preferred.
  • Certification as a Case Manager is preferred.
  • Minimum 3 years experience in acute care setting preferred.
  • Managed Care experience is preferred.
  • Ability to talk and type at the same time.
  • Demonstrate critical thinking skills when interacting with members.
  • Strong computer skills (including 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.
  • Strong organization and time management skills with the ability to work independently.

Benefits

  • merit increases
  • paid holidays
  • Paid Time Off
  • incentive bonus programs
  • medical
  • dental
  • vision
  • short and long term disability benefits
  • 401(k) +match
  • stock purchase plan
  • life insurance
  • wellness programs
  • financial education resources

Job title

Nurse Case Manager I, NICU

Job type

Experience level

Mid levelSenior

Salary

Not specified

Degree requirement

Bachelor's Degree

Location requirements

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