Nurse Case Manager - NICU (must reside/be licensed in South Carolina)

About the role

The Case Manager will empower members' families to support optimal wellness and advocate for necessary medical services across the health care continuum. This role operates in a telephonic managed care setting, combining clinical knowledge and critical thinking to facilitate a plan of care that ensures quality medical care for high-risk member populations according to CMSA national standards.

Responsibilities

• Assesses physical, functional, psychological, environmental, educational, and financial needs of members.
• Completes needs assessments and develops individualized care plans for all members as per ProgenyHealth policies and procedures.
• Assigns risk stratification based on medical and social needs and determines call frequency to monitor the care plan.
• Interfaces with providers to coordinate care activities such as appointments, transportation, durable medical equipment (DME), etc.
• Provides education to members about their conditions, treatment plans, benefits, and how to access needed care.
• Maintains ongoing progress towards goal achievement and reassesses health status changes throughout the care continuum.
• Refers members to appropriate community resources and facilitates communication among multiple service providers.
• Participates in interdisciplinary and client rounds with healthcare team members to identify, clarify, and prevent risks, quality issues, or plan of care discrepancies.

Requirements

• Current, unrestricted RN license in South Carolina.
• Bilingual in Spanish is preferred.
• College degree is preferred.
• Experience in a Case Management role is preferred.
• Three (3) or more years of clinical experience in a Level III or above NICU.
• CCM certification required within company policy timeframe.
• Experience with data entry into a database or Electronic Health Record (EHR).
• Excellent communication and organizational skills.
• Self-motivated and willing to learn multiple tasks.
• Well-organized and able to prioritize tasks.
• Demonstrated accuracy in spelling and documentation.
• Strong interpersonal skills, telephone etiquette, and positive communication.
• Commitment to excellence in customer service.

Qualifications

• Registered Nurse (RN) with a current, unrestricted license in South Carolina.
• Resides in South Carolina.
• Three (3) or more years of clinical experience in a Level III or above NICU.
• CCM certification required within the timeframe specified by company policy.
• Experience with data entry into a database or EHR.
• Excellent communication and organizational skills.
• Self-motivated and willing to learn multiple tasks.
• Well-organized and able to prioritize tasks.
• Demonstrated accuracy in spelling and documentation.
• Strong interpersonal skills, telephone etiquette, and positive communication.
• Commitment to excellence in customer service.

Skills

• Strong clinical knowledge and critical thinking skills.
• Effective communication and problem-solving abilities.
• Ability to manage multiple tasks and prioritize responsibilities.
• Knowledge of relevant healthcare policies and procedures.
• Proficiency in data entry and EHR systems.

Benefits

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