Integrated Nurse Case Manager, RN – Maternity/OBGYN
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: • Associate or Bachelors Degree in Nursing REQUIRED • 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 in Maternity/OB/Labor & Delivery/Mother Baby/Postpartum/Pregnant population preferred • Strong knowledge of physical, psychological, socio-cultural, and cognitive patient needs • Excellent communication skills, both oral and written • Strong problem-solving and analytical skills • Ability to perform telephonic or face-to-face clinical assessments • Ability to work standard hours 8am to 5pm EST, Monday-Friday (40 hours/week) • Must be located in and eligible to work remotely in Virginia 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 • Opportunity to earn an annual discretionary bonus if eligibility criteria are met • Family-friendly culture, community involvement, and professional development opportunities Apply tot his job