Assesses the physical, functional, psychological, environmental, educational, and financial needs of members referred to the Case Management program.
Completes needs assessments for all members in CM and develops care plans individualized to the needs of each member as per ProgenyHealth policies and procedures.
Assigns risk stratification based on complexity of medical and social needs and determines ongoing frequency of calls to continually assess plan of care.
Monitors the care plan to ensure effective, appropriate provision of services and adequacy of benefits.
Interfaces with providers to assist with care coordination activities, which can include appointments, transportation, DME, etc.
Provides education to members regarding condition, treatment plan, benefits, services, and how to access needed care.
Monitors ongoing progress towards goal achievement and reassess changes in health status throughout continuum of care.
Provides referrals to appropriate community resources; facilitates access and communication when multiple services are involved; monitors activities to ensure that services are actually being delivered and meeting the needs of the member.
Participates in interdisciplinary and client rounds with pertinent health care team members to identify, clarify, and/or prevent risk, quality, or plan of care variances.

Registered Nurse (RN) with a current, unrestricted compact license is required
College degree is preferred
Scheduled hours will be in central, mountain or pacific time zone
Three or more years of experience in a Case Management role is required
Previous experience in a maternity management program preferred
Three or more years of clinical experience in OB/L&D or related area is required
CCM certification required within the timeframe specified by company policy
Experience with data entry into a database or EHR required
Must be computer literate
Excellent communication skills and organizational ability are required
Must be self-motivated and willing to learn multiple tasks
Must be well organized and able to prioritize tasks
Must demonstrate accuracy in spelling and documentation
Demonstrated strength in working independently as well as collaboratively within a team
Must have excellent interpersonal skills, telephone etiquette, and maintain positive communication at all times
Must have commitment to excellence in customer service.

Nurse Case Manager – Maternity

Key skills