Pediatric Nurse Case Manager SR

Pediatric Nurse Case Manager Sr Location: Washington, DC. This role is hybrid; requires in‑office presence 4 days per week while offering flexibility to support productivity and work‑life balance. Candidates must be within a reasonable commuting distance unless accommodations are granted by law. Responsibilities Ensures member access to services appropriate to their health needs. Conducts assessments to identify individual needs and creates a care management plan to address objectives and goals 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, presents cases for discussion at Grand Rounds/Care Conferences, and participates in interdepartmental and/or cross‑brand workgroups. May develop a focused skill set, including comprehensive knowledge of specific disease processes or traumatic injury, and serve as a preceptor for new care management staff. Participates in department audit activities. Minimum Requirements BA/BS in a health‑related field and minimum of 5 years of clinical experience; or any combination of education and experience that is equivalent. Current, unrestricted RN license in applicable state(s). Multi‑state licensure is required if providing services in multiple states. Preferred Skills, Capabilities, and Experience Certification as a Case Manager preferred. Experience in Pediatrics preferred. Salary & Benefits Salary range: $91,724 - $137,586. A comprehensive benefits package is offered, including health, dental, vision, short‑ and long‑term disability, 401(k) with company match, stock purchase plan and additional incentive and recognition programs. Equal Employment Opportunity 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 (including gender identity and gender expression), marital status, national origin, race, religion, sex, sexual orientation, veteran status or any other status or condition protected by applicable federal, state, and local laws. Applicants who require accommodation to participate in the job application process may contact View email address on click.appcast.io for assistance. #J-18808-Ljbffr