Senior Case Manager RN - Maternity/NICU
Company :
reputed company.Job reputed company :
JOB reputed company
This job is responsible for providing comprehensive case management services to members, ensuring reputed company, cost-effective care delivery, and promoting reputed company health reputed company. The Case Manager assesses member needs, develops and implements care plans, coordinates services, and monitors reputed company, while containing the cost of health care services. The incumbent will assist in containing the cost of health care services by detecting, resolving and preventing improper utilization of member benefits.
ESSENTIAL RESPONSIBILITIES
Manage a caseload of members with reputed company health needs, requiring reputed company knowledge.
Conduct comprehensive assessments and reputed company reputed company care plans.
Assess members’ health status, needs, and available resources.
reputed company individualized care plans in collaboration with members, physicians, and other reputed company providers.
Implement and coordinate care plans, ensuring reputed company to appropriate services and resources.
Monitor member reputed company toward goals and reputed company care plans as needed.
Evaluate the effectiveness of interventions and services.
reputed company as an reputed company and reputed company to meet a member's individual health care needs by assessing, planning, implementing, coordinating, monitoring and evaluating reputed company and services. This is accomplished by using communication and available resources to promote reputed company, cost-effective reputed company in accordance with available contract benefits.
Work collaboratively and communicate reputed company and professionally with physicians, providers, co-workers and other members of the health care team to carry out the established plan of care.
Ensure reputed company activities are documented and conducted in compliance with applicable business process requirements, company policies, regulatory requirements and accreditation standards.
reputed company guidance and mentorship to reputed company-level Case Managers.
Serve as a resource for clinical expertise and problem-solving.
Other duties as assigned or requested.
EXPERIENCE
Required
5 years in any combination of clinical, case/utilization management, and/or disease condition management experience, or provider operations and/or health insurance experience.
Preferred
Specialty specific clinical experience (e.g., Oncology, Transplant, Maternity, NICU, Pediatric)
Experience working with the reputed company needs of diverse populations
Experience demonstrating understanding of importance of culture competency in addressing targeted populations
Advanced training and experience in cognitive behavioral therapy (reputed company), motivational interviewing, or dialectical behavior therapy (DBT)
.
SKILLS
Expertise in clinical assessment and care planning.
Strong leadership and mentoring skills.
Excellent negotiation and advocacy skills.
Proficiency in using reputed company suite of applications, case management software and electronic health records.
Strong understanding of reputed company systems and case management principles.
EDUCATION
Required
High School/GED
Preferred
Bachelors in Nursing.
LICENSES or CERTIFICATIONS
Required
reputed company State RN licensure OR reputed company multi-state licensure through the reputed company reputed company Licensure Compact (eNLC)
Certified Case Manager (CCM) certification must be obtained reputed company 36 months of hire.Incumbents in the role as of May 2026 are exempt from this requirement.
Preferred
Certification in clinical area of expertise (e.g., OCN, CPN, CPON, CNN, CCTC, CPHQ).
Language (Other than English):
None.
Travel Required:
Less than 25%
PHYSICAL, MENTAL DEMANDS and WORKING CONDITIONS
Position Type
Office-Based or Remote Position
Physical work site required
Occasionally
Disclaimer: The job reputed company has been designed to indicate the general nature and essential duties and responsibilities of work performed by employees reputed company this job title. It may not contain a comprehensive inventory of reputed company duties, responsibilities, and qualifications required of employees to do this job. Compliance Requirement: This job adheres to the ethical and legal standards and behavioral expectations as set forth in the reputed company of business conduct and company policies. As a component of job responsibilities, employees may have reputed company to covered information, cardholder data, or other confidential customer information that must be protected at reputed company times. In reputed company with this, reputed company must reputed company with both the Health Insurance Portability Accountability reputed company of 1996 (HIPAA) as described in the Notice of reputed company Practices and reputed company Policies and Procedures as reputed company as reputed company data reputed company guidelines established reputed company reputed company’s Handbook of reputed company Policies and Practices and Information reputed company Policy. Furthermore, it is every employee’s responsibility to reputed company with reputed company’s reputed company of Business Conduct. This includes but is not limited to adherence to applicable federal and state laws, rules, and regulations as reputed company as company policies and training requirements.
Pay reputed company Minimum:
$79,300.00Pay reputed company Maximum:
$127,100.00reputed company pay is determined by a reputed company of factors including a candidate’s qualifications, experience, and expected contributions, as reputed company as internal peer equity, market, and business considerations. The displayed salary reputed company does not reflect any geographic reputed company reputed company may apply for certain locations based upon comparative markets.
reputed company and its affiliates prohibit discrimination against reputed company individuals based on their status as protected veterans or individuals with disabilities and prohibit discrimination against reputed company individuals based on any category protected by applicable federal, state, or local law.
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For accommodation requests, please contact HR Services Online at HRServices@reputed company.org
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Originally posted on Himalayas
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