Collaborates with members of an inter-disciplinary care team (ICT)
Facilitates communication, coordinates care and service of the member through assessments
Engage the member and their natural support system through strength-based assessments
Develop a person-centered individualized care plan (ICP) in collaboration with the ICT
Identify and manage barriers to achievement of care plan goals
Act as a liaison to social service agencies, community-based organizations and support groups
Educate the member/natural supports about community resources, insurance benefits
Verify eligibility, previous enrollment history, demographics and current health status of each member
Complete psychosocial and behavioral assessments by gathering information from the member and stakeholders
Assess for clinical risk factors that could result in readmission

Associates of Science (A.S) in nursing or Bachelor's degree in healthcare field required
Bachelor of Science (B.S) in nursing preferred or Master of Science (M.S) associated with clinical licensure preferred
Three (3) years of maternity/NICU experience in nursing, or health care profession required
Three (3) years Medicaid and/or Medicare managed care experience preferred
Strong understanding of Quality, HEDIS, disease management, supportive medication reconciliation and adherence
Intermediate proficiency level with Microsoft Office, including Outlook, Word and Excel
Current unrestricted clinical license in state of practice as a Registered Nurse, Social Worker or Professional or Clinical Counselor required
Licensure in multiple states as applicable based on State requirement of the work assigned may be required
Case Management Certification within 2 years of hire required

Care Manager – Post Partum

Key skills