RN Maternity Case Mgr

What is your impact?

The RN Maternity Case Manager will be a member of our Case Management department and will work within the Maternity Management program, which assists in managing healthcare costs for expectant mothers. The RN Maternity Manager (MM) focuses on wellness/wellbeing and education of expectant mothers, as well as traditional case management practices as it relates to mothers-to-be with high-risk pregnancies.

Maternity Case Management Process

• Assess the member’s health status and care coordination needs.
• Contact with patient, family, physicians, additional health care providers, and community resources.
• Contact with provider business offices and with the employer/client may also be required.
• Identify alternative treatment plans, which would have to be approved by all parties.
• Maintain the health status and the impact of the treatment plan for each member.
• Identify services, resources, providers, and facilities that could best serve members in a timely and cost-effective manner, to promote optimum value for the member and reimbursement source.
• Develop and implement Case Management goals, both short and long term, with documented care plans.
• Utilize technology/resources to evaluate the cost-effectiveness of the elected treatment plan, pre-implementation and post-implementation.
• Accurately and timely report as deemed appropriate by each client.
• Interpret individual health plans and authorize/coordinate care in accordance with plan provisions.

What You Must Have

• 5+ years professional work experience in clinical nursing and patient assessment.
• Related Bachelor’s degree or additional related equivalent work experience.
• Graduate of an accredited school of nursing.
• RN - Registered Nurse - State Licensure in good standing.
• RN Compact State Licensure.

What We Prefer

• (CCM) Certified Case Manager preferred.
• Prior experience with maternal health, prenatal care, and/or high-risk pregnancy management in a clinical setting.
• Prior experience in utilization management or case management preferred, preferably within the managed care environment.
• Knowledgeable in medical terminology, reasonable and necessary treatment plans, delivery quality health care services and cost containment practices.
• Ability to collaborate with cross-operational areas within the organization.
• Intensive care or higher-acuity patient experience preferred.
• Knowledge of managed care in a self-funded employer population is preferred.
• Ability to identify problems such as underutilization or overutilization of services.
• Ability to promote and maintain quality care through analysis.

Physical Demands

Sedentary work: Exerting up to 10 pounds of force occasionally to move objects. Jobs are sedentary if traversing activities are required only occasionally.

Physical/Environmental Activities

Must be able to travel to multiple locations for work (i.e. travel to attend meetings, events, conferences). Occasionally.