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Senior Nurse Case Manager
2 months ago
We are seeking a highly skilled Senior Nurse Case Manager to lead our Maternal Child Health operations. As a key member of our team, you will be responsible for care management within the scope of licensure for members with complex and chronic care needs.
Key Responsibilities- Assess, develop, implement, coordinate, monitor, and evaluate care plans designed to optimize member healthcare across the care continuum.
- Lead the day-to-day activities of the Maternal Child Health operations, including OB High Risk programs, NICU, and whole health initiatives.
- Oversight of staff day-to-day activities and coaching for performance metrics to achieve program goals.
- 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 within benefits structure or through extra-contractual arrangements.
- Coordinate internal and external resources to meet identified needs.
- Monitor and evaluate effectiveness of the care management plan and modify as necessary.
- Interface with Medical Directors and Physician Advisors on the development of care management treatment plans.
- Negotiate rates of reimbursement, as applicable. Assist in problem solving with providers, claims or service issues.
- BA/BS in a health-related field and minimum of 5 years of clinical experience; or any combination of education and experience, which would provide an equivalent background.
- Current, unrestricted RN license from the state of New York is required.
- Certification as a Case Manager is preferred.
- At least 5 years of Case Management experience in Maternal and Child Health is a must for this role.
- Previous Medicaid experience is highly preferred.
- You must be computer literate in Microsoft applications including Word and Excel.
Elevance Health is a health company dedicated to improving lives and communities – and making healthcare simpler. We are a Fortune 25 company with a longstanding history in the healthcare industry, looking for leaders at all levels of the organization who are passionate about making an impact on our members and the communities we serve.
