Nurse Case Manager I, Obstetrics

Role Overview

• Responsible for performing care management within the scope of licensure for members with complex and chronic care needs
• Assessing, developing, implementing, coordinating, monitoring, and evaluating care plans designed to optimize member health care
• Ensures member access to services appropriate to their health needs
• Conducts assessments to identify individual needs and a specific care management plan
• Implements care plan by facilitating authorizations/referrals as appropriate
• 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

Requirements

• Requires BA/BS in a health related field and minimum of 3 years of clinical experience
• 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
• 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

• merit increases
• paid holidays
• Paid Time Off
• incentive bonus programs
• medical benefits
• dental benefits
• vision benefits
• short term disability benefits
• long term disability benefits
• 401(k) +match
• stock purchase plan
• life insurance
• wellness programs
• financial education resources