Nurse Case Manager - NICU (must be bilingual in Haitian Creole)

About the Role

The Case Manager will focus on empowering members' families to support optimal wellness while advocating for necessary medical services across the healthcare continuum. This role operates in a telephonic managed care setting, combining strong clinical knowledge and critical thinking to facilitate a plan of care that ensures quality medical care for high-risk members, based on CMSA national standards for case management practice.

Responsibilities

• 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 Case Management and develops individualized care plans as per ProgenyHealth policies and procedures.
• Assigns risk stratification based on the complexity of medical and social needs and determines ongoing frequency of calls to continually assess the 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, including appointments, transportation, and DME.
• Provides education to members regarding their condition, treatment plan, benefits, services, and how to access needed care.
• Monitors ongoing progress toward goal achievement and reassesses changes in health status throughout the continuum of care.
• Provides referrals to appropriate community resources; facilitates access and communication when multiple services are involved; monitors activities to ensure services are delivered and meet the member's needs.
• Participates in interdisciplinary and client rounds with healthcare team members to identify, clarify, and/or prevent risk, quality, or plan of care variances.

Requirements

• Registered Nurse (RN) with a current, unrestricted compact license is required.
• Three (3) or more years of clinical experience in a Level III or above NICU 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 with excellent communication skills and organizational ability.
• Must be self-motivated, 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.
• Commitment to excellence in customer service.

Qualifications

• Preferred: EST time zone.
• Must be bilingual in Haitian Creole.
• College degree is preferred.
• Experience in a Case Management role is preferred.

Benefits

• Paid Time Off
• Paid Parental Leave
• Medical, dental, and vision benefits
• 401K with company match
• Short- and Long-Term Disability
• Group Life Insurance
• Tuition reimbursement
• Professional development opportunities
• Business Casual work environment