Case Manager

Maternal Child Nurse Case Manager IShift: Monday – Friday, 8:00am – 5:00pm CSTLocation: Virtual, Grand Prairie, TX, Alternate locations may be considered if candidates reside within a commuting distance from an officeThis role enables associates to work virtually full-time, with the exception of required in-person training sessions, providing maximum flexibility and autonomy. This approach promotes productivity, supports work-life integration, and ensures essential face-to-face onboarding and skill development.Please note that 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 lawThe Maternal Child Nurse Case Manager I is responsible for performing 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 impact:Ensures 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.Minimum requirements:Requires BA/BS in a health related field and minimum of 3 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.Current and active RN license required in applicable state(s).Preferred skills, capabilities, and experiences:OB and NICU and/or Mother baby experience preferredCertification as a Case Manager is preferred.Certification as a Case Manager and a BS in a health or human services related field preferred.Job Level: Non-Management ExemptWorkshift: 1st Shift (United States of America)Job Family: MED > Licensed Nurse