OB Care Manager

About the role

This position is responsible for the planning, development, implementation, and timely oversight of care plans for members with identified Care Management (CM) needs. The incumbent is responsible for managing the care management process as defined by improving coordination, continuity, accessibility, and appropriate utilization of health care services and community resources for high risk and special needs members.

Responsibilities

• Assists in developing, maintaining, and monitoring processes to promote the timely identification and assessment of high risk and special needs members.
• Serves as an interdisciplinary team member in management of identified members, performing clinical/social determinants of health assessments and in collaboration with physicians, determining medical needs.
• Conducts telephone or face-to-face interviews of members to identify risk factors and the need for care management.
• Fosters professional networks and relationships with service and resource providers to promote continuity and quality of care for members.
• Initiates, develops, plans, and implements care plans designed to promote the delivery of quality care and service to members with identified CM needs.
• Utilizes clinical judgment to discharge members from care management according to plan policies and procedures.
• Maintains care management records according to plan policies and procedures and ensures data integrity in health plan information systems.
• Educates members' medical providers regarding the members' special needs to ensure consideration to the unique needs of the patients in treatment planning.
• Collaborates with community support and social service systems for members.

Requirements

• The ability to successfully utilize Microsoft Office suite and common computer and office hardware is necessary.
• Able to perform mathematical skills and simple stats accurately.
• Able to conduct presentations and training before small and large groups.
• Knowledge of the American with Disabilities Act of 1990.
• Demonstrated skill in written and oral communication including presentations and training before small and large groups.
• Registered Nurse with current state license (in good standing)
• 2+ years of clinical nursing experience in an acute care or community setting
• 2+ years OB/GYN experience
• Experience assisting members using community agencies
• 2 years of managed care experience preferred
• CCM/BSN preferred

Education and Work Experience

• Registered Nurse with current state license (in good standing)
• 2+ years of clinical nursing experience in an acute care or community setting
• 2+ years OB/GYN experience
• Experience assisting members using community agencies
• 2 years of managed care experience preferred
• CCM/BSN preferred

Secondary Functions

• Following HIPAA guidelines, the Care Manager maintains confidentiality of patient information and adheres to appropriate release of medical information procedures.
• Identifies and reports gaps in the service delivery system.

Benefits

Along with competitive pay, we offer excellent benefits (medical, dental, and vision plans, 100% employer Term Life Insurance, Short and Long-Term Disability, 401k Employer Match up to 4%) as well as 20 days of PTO, and tuition assistance/professional development plans. We are also committed to Diversity, Equity, and Inclusion, providing organizational-wide social opportunities, and constantly improving our ongoing efforts to positively impact our members' lives.