Maternity Case Manager

About the role

We’re looking for the next generation of health care leaders. At AmeriHealth Caritas, we’re passionate about helping people get care, stay well and build healthy communities. As one of the nation's leaders in health care solutions, we offer our associates the opportunity to impact the lives of millions of people through our national footprint of products, services and award-winning programs. AmeriHealth Caritas is seeking talented, passionate individuals to join our team. Together we can build healthier communities.

Responsibilities

• Provide support to pregnant members appropriate for care coordination and case management services in achieving their optimal level of health through self-management.
• Engage the member, member caregiver, and providers to assess, plan and establish individual member goals.
• Facilitate and coordinate care for the members throughout the pre- and post-partum period while assuring quality and use of cost-effective resources.
• Function as a single point of contact and advocate for the members through their pregnancy.
• Assess members to determine care coordination and care management needs for all referred members.
• Complete comprehensive person-centered assessment inclusive of physical health history, psycho-social health, environmental, as well as, social determinants of health and supportive needs.
• Coordinate physical, behavioral health and social services.
• Provide medication management, including regular medication reconciliation and support of medication adherence.
• Identify problems/barriers for care coordination and appropriate care management interventions.
• Create a plan of care to assist members in reducing/resolving problems and/or barriers so that members may achieve their optimal level of health.
• Identify both short and long-term goals and associated time frames for completion; share goals with the member and family as appropriate.
• Identify and implement the appropriate level of intervention based upon the member’s needs and clinical progress.
• Schedule follow-up calls as necessary, make appropriate referrals, and implement actions to address member issues.
• Document progress towards meeting goals and resolving problems.
• Coordinate care and services with the Care Coordinator, Community Health Navigator, member and member caregiver as appropriate, PCP, Specialist, and Facility/Vendor Providers.
• Meet face to face with members in the community, on occasion, based on their needs.

Requirements

• Active and unencumbered Registered Nurse license in North Carolina.
• Minimum of 3 years of professional practice experience in maternity to include high risk OB and labor and delivery.
• 3+ years of nursing experience required, working with Medicaid populations, either in the hospital or community health setting.
• Valid driver’s license with car insurance.

Preferred Qualifications

• 3 to 5 years of Case/Care Management experience.

Work Arrangement

• Qualified candidates must reside within a 30 minute drive of Concord, North Carolina or Kannapolis, North Carolina.
• Monday through Friday, 8:30 AM EST to 5:00 PM EST.

Benefits

• Flexible work solutions including remote options and hybrid work schedules.
• Competitive pay.
• Paid time off including holidays and volunteer events.
• Health insurance coverage for you and your dependents on Day 1.
• 401(k).
• Tuition reimbursement.