RN Care Manager – Maternity

Role Overview

• The Care Manager is responsible for the coordination of services for members who meet established criteria, with an emphasis on education/self-management and promoting quality care and cost-effective outcomes.
• The Care Manager uses a collaborative process to assess Member needs, review options for services and resources, develop and implement a plan of care, coordinate resources, monitor progress, evaluate Member status, discharge Members, and fully document the individualized member care management process and outcome.
• The Care Manager will address medical, psychosocial, clinical needs, and behavioral health needs including members with mental health and substance use disorder needs.
• Care Managers provide counseling and referrals to community/local/state programs; collaborate with caregivers, providers, community agencies, behavioral health, and other resources to coordinate care to achieve member’s optimal health status.
• The Care Manager is responsible for the management and oversight of a caseload of moderate
• high risk Members with complex medical/behavioral /psychosocial needs.

Requirements

• Registered Nurse with active licensure in home state; additional state’s licensure as needed/required to meet customer needs
• Certified Case Management certification within 2 years of employment
• At least three (3) years’ recent/related experience; care management, home health, medical/surgical behavioral health, and/or critical care preferred
• Knowledge of NCQA standards for Population Health Management for health plan accreditation
• Knowledge of evidence-based guidelines for chronic conditions/care management
• Ability to operate a personal computer (PC), including proficiency in Microsoft Office Products.

Benefits

• Medical, Dental & Vision coverage
• Retirement Plan
• Generous time off including Paid Time Off
• Holidays
• Volunteer time off
• Incentive Plan
• Tuition Reimbursement
• More