OB Nurse Case Mgr SR

OB Nurse Case Manager SrLocation: Washington, DC. This role requires associates to be in-office 4 days per week, fostering collaboration and connectivity, while providing flexibility to support productivity and work-life balance. This approach combines structured office engagement with the autonomy of virtual work, promoting a dynamic and adaptable workplace.Per our policy on hybrid/virtual work, candidates not within a reasonable commuting distance from the posting location(s) will not be considered for employment unless an accommodation is granted as required by law.The OB Nurse Case Manager Sr will be responsible for care management within the scope of licensure for members with complex and chronic care needs by assessing, developing, implementing, coordinating, monitoring, and evaluating care plans designed to optimize member health care across the care continuum. Performs duties telephonically or on-site such as at hospitals for discharge planning.How You Will Make An ImpactEnsures member access to services appropriate to their health needs.Conducts assessments to identify individual needs and 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.Coordinates internal and external resources to meet identified needs.Monitors and evaluates effectiveness of the care management plan and modifies as necessary.Interfaces with Medical Directors and Physician Advisors on the development of care management treatment plans.Negotiates rates of reimbursement, as applicable.Assists in problem solving with providers, claims or service issues.Assists with development of utilization/care management policies and procedures, chairs and schedules meetings, as well as presents cases for discussion at Grand Rounds/Care Conferences and participates in interdepartmental and/or cross brand workgroups.May require the development of a focused skill set including comprehensive knowledge of specific disease process or traumatic injury and functions as preceptor for new care management staff.Participates in department audit activities.Minimum RequirementsRequires 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 in applicable state(s) required.Multi-state licensure is required if this individual is providing services in multiple states.Preferred Skills, Capabilities And ExperiencesExperience with OB preferred.Certification as a Case Manager is preferred.Salary: $91,724 - $137,586 (Washington, DC).Elevance Health offers a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution. The offered salary is based on legitimate, non-discriminatory factors set by the Company.Elevance Health is an Equal Employment Opportunity employer and all qualified applicants will receive consideration for employment without regard to age, citizenship status, color, creed, disability, ethnicity, genetic information, gender, marital status, national origin, race, religion, sex, sexual orientation, veteran status or any other status or condition protected by applicable federal, state, or local laws. Applicants who require accommodation to participate in the job application process may contact elevancehealthjobssupport@elevancehealth.com for assistance.Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state, and local laws, including, but not limited to, the Los Angeles County Fair Chance Ordinance and the California Fair Chance Act.Prospective employees required to be screened under Florida law should review the education and awareness resources at HB531 | Florida Agency for Health Care Administration.#J-18808-Ljbffr