NICU Nurse Case Manager I

2 weeks ago

Denver, Colorado, United States Elevance Health Full time

Sign-on Bonus: $2000.

At Federal Health Products and Services - FHPS, a proud member of Elevance Health, Inc., we are committed to enhancing access to healthcare for our members and delivering value to our customers while improving community health.

Position Overview:
This role is primarily virtual, but candidates must reside within 50 miles of an Elevance Health Pulse Point.

Work Schedule:
Monday - Friday, 10 am - 6:30 pm EST.

The Telephonic Nurse Case Manager I is tasked with managing care for members with complex and chronic health conditions. This includes assessing, developing, implementing, coordinating, monitoring, and evaluating care plans aimed at optimizing health outcomes across the care continuum.

Key Responsibilities:

  • Conduct assessments to determine individual needs and create tailored care management plans.
  • Implement care plans by facilitating necessary authorizations and referrals within the benefits framework.
  • Monitor and assess the effectiveness of care management plans, making adjustments as needed.
  • Collaborate with Medical Directors and Physician Advisors to develop treatment plans.
  • Negotiate reimbursement rates as applicable.
  • Assist in resolving issues related to providers, claims, or services.
  • Contribute to the development of utilization and care management policies and procedures.

Qualifications:
Requires a BA/BS in a health-related field and a minimum of 5 years of clinical experience; a degree in a health or human services-related field is preferred.

  • Experience in obstetrics is strongly preferred.
  • NICU experience is advantageous.
  • Familiarity with the medical management process and the ability to interpret member contracts and managed care products is highly desirable.
  • Prior experience in managed care is strongly preferred.

Compensation:
The salary range for this position is $72,080 to $118,932, depending on experience and qualifications.

In addition to competitive salaries, Elevance Health offers a comprehensive benefits package, including incentive programs, stock purchase options, and 401(k) contributions, all subject to eligibility requirements.

Elevance Health is dedicated to ensuring equal pay opportunities for equal work, regardless of gender, race, or any other protected category.

Company Overview:
Elevance Health is a leading health company focused on improving lives and communities while simplifying healthcare. As a Fortune 25 organization, we seek passionate leaders at all levels to make a meaningful impact on our members and the communities we serve.

We are committed to fostering a culture that promotes personal and professional growth for our associates, driving our shared success across consumers, associates, communities, and our business.

Elevance Health operates under a Hybrid Workforce Strategy, requiring associates to work at an Elevance Health location at least once per week unless specified otherwise.

The health and safety of our associates and communities are a top priority. We require candidates in certain patient-facing roles to be vaccinated against COVID-19, adhering to all relevant laws.

Elevance Health is an Equal Employment Opportunity employer, and all qualified applicants will receive consideration for employment without regard to any status protected by applicable laws.

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