RN Nurse Case Mgr I (OB & Peds)
About the position Responsibilities • Ensures member access to services appropriate to their health needs. • Conducts assessments to identify individual needs and develops a specific care management plan. • Implements care plans by facilitating authorizations/referrals as appropriate. • Coordinates internal and external resources to meet identified needs. • Monitors and evaluates the effectiveness of the care management plan and modifies as necessary. • Interfaces with Medical Directors and Physician Advisors on care management treatment plans. • Negotiates rates of reimbursement, as applicable. • Assists in problem solving with providers, claims, or service issues. Requirements • BA/BS in a health-related field and a minimum of 3 years of clinical experience, or equivalent education and experience. • Current, unrestricted RN license from the state of Maryland. Nice-to-haves • Previous high-risk obstetrics and high-risk pediatric nursing experience. • Previous experience as a case manager. • Previous Medicaid and/or Managed Care experience. Benefits • Comprehensive benefits package • Incentive and recognition programs • Equity stock purchase • 401k contribution • Paid holidays • Paid Time Off • Medical, dental, vision benefits • Short and long-term disability benefits • Life insurance • Wellness programs • Financial education resources Apply tot his job