Integrated Nurse Case Manager, Registered Nurse (RN) – Maternity, OBGYN
Job Description:
• Responsible for case management services within the scope of licensure;
• Develops, monitors, evaluates, and revises the member's care plan to meet the member's needs, with the goal of optimizing member health care across the care continuum.
• Performs telephonic or face-to-face clinical assessments for the identification, evaluation, coordination and management of member's needs, including physical and behavioral health, social services and long-term services.
• Identifies members for high-risk complications and coordinates care in conjunction with the member and health care team.
• Manages chronic illnesses, co-morbidities, and/or disabilities ensuring cost effective and efficient utilization of health benefits; conducts gap in care management for quality programs.
• Assists with the implementation of member care plans by facilitating authorizations/referrals within benefits structure or extra-contractual arrangements, as permissible.
• Interfaces with Medical Directors, Physician Advisors and/or Inter-Disciplinary Teams on care management treatment plans.
• Presents cases at case conferences for multidisciplinary focus.
• Ensures compliance with regulatory, accrediting and company policies and procedures.
• May assist in problem solving with provider, claims or service issues.
Requirements:
• Bachelors Degree in Nursing preferred
• Registered Nurse (RN) License (Compact or Virginia) REQUIRED
• 3 years experience in Nursing REQUIRED
• Case Management experience preferred
• Managed Care or Health Plan experience preferred
• Experience working with low and high risk pregnant population/Maternity/OB/L&D/Mother Baby/Postpartum experience preferred
• Strong knowledge of physical, psychological, socio-cultural, and cognitive patient needs.
• Excellent communication skills, both oral and written, as well as strong problem-solving and analytical skills.
Benefits:
• Medical, Dental, Vision plans
• Adoption, Fertility and Surrogacy Reimbursement up to $10,000
• Paid Time Off and Sick Leave
• Paid Parental & Family Caregiver Leave
• Emergency Backup Care
• Long-Term, Short-Term Disability, and Critical Illness plans
• Life Insurance
• 401k/403B with Employer Match
• Tuition Assistance – $5,250/year and discounted educational opportunities through Guild Education
• Student Debt Pay Down – $10,000
• Reimbursement for certifications and free access to complete CEUs and professional development
• Pet Insurance
• Legal Resources Plan
• Colleagues have the opportunity to earn an annual discretionary bonus if established system and employee eligibility criteria is met.
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• Responsible for case management services within the scope of licensure;
• Develops, monitors, evaluates, and revises the member's care plan to meet the member's needs, with the goal of optimizing member health care across the care continuum.
• Performs telephonic or face-to-face clinical assessments for the identification, evaluation, coordination and management of member's needs, including physical and behavioral health, social services and long-term services.
• Identifies members for high-risk complications and coordinates care in conjunction with the member and health care team.
• Manages chronic illnesses, co-morbidities, and/or disabilities ensuring cost effective and efficient utilization of health benefits; conducts gap in care management for quality programs.
• Assists with the implementation of member care plans by facilitating authorizations/referrals within benefits structure or extra-contractual arrangements, as permissible.
• Interfaces with Medical Directors, Physician Advisors and/or Inter-Disciplinary Teams on care management treatment plans.
• Presents cases at case conferences for multidisciplinary focus.
• Ensures compliance with regulatory, accrediting and company policies and procedures.
• May assist in problem solving with provider, claims or service issues.
Requirements:
• Bachelors Degree in Nursing preferred
• Registered Nurse (RN) License (Compact or Virginia) REQUIRED
• 3 years experience in Nursing REQUIRED
• Case Management experience preferred
• Managed Care or Health Plan experience preferred
• Experience working with low and high risk pregnant population/Maternity/OB/L&D/Mother Baby/Postpartum experience preferred
• Strong knowledge of physical, psychological, socio-cultural, and cognitive patient needs.
• Excellent communication skills, both oral and written, as well as strong problem-solving and analytical skills.
Benefits:
• Medical, Dental, Vision plans
• Adoption, Fertility and Surrogacy Reimbursement up to $10,000
• Paid Time Off and Sick Leave
• Paid Parental & Family Caregiver Leave
• Emergency Backup Care
• Long-Term, Short-Term Disability, and Critical Illness plans
• Life Insurance
• 401k/403B with Employer Match
• Tuition Assistance – $5,250/year and discounted educational opportunities through Guild Education
• Student Debt Pay Down – $10,000
• Reimbursement for certifications and free access to complete CEUs and professional development
• Pet Insurance
• Legal Resources Plan
• Colleagues have the opportunity to earn an annual discretionary bonus if established system and employee eligibility criteria is met.
Apply tot his job
Apply To this Job