Nurse Case Manager I, Obstetrics

About the role

This role enables associates to work virtually full-time, except for 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.

Responsibilities

• Ensures member access to services appropriate to their health needs.
• Conducts assessments to identify individual needs and develop 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.
• Captures and coordinates internal and external resources to meet identified needs.
• Makes sure the care management plan is effective and modifies it as necessary.
• Interfaces with Medical Directors and Physician Advisors on the development of care management treatment plans.
• Negotiates rates of reimbursement, as applicable.
• Aids in problem solving with providers, claims or service issues.

Requirements

• Requires BA/BS in a health related field and 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.
• Tennessee residency is a requirement for this role.

Preferred Skills, Capabilities And Experiences

• Experience in case management is preferred.
• Experience in care of Pregnancy and/or Labor and Delivery/Postpartum is preferred.
• Hospital OB experience is preferred.
• Certification as a Case Manager is preferred.

Benefits

At Elevance Health, we offer a range of market-competitive total rewards that include 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.

Pay

Details on pay are not specified in the job posting.

Schedule

Details on schedule are not specified in the job posting.