RN Nurse Case Mgr I (OB & Peds)
About the positionResponsibilities• 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 resourcesApply Now
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