Job Summary
The OB Care Manager – Nursing Field (RN CM) will ensure that all pregnant members receive timely care management (CM) across the continuum, including transitions of care, care coordination and navigation, complex case management, population health and wellness interventions, and disease/chronic condition management per department guidelines. The nurse care manager possesses strong clinical knowledge, critical thinking skills, and ability to facilitate a care plan which ensures quality medical care for the member. The OB RN CM works closely with the member, the caregiver/authorized representative, and providers to meet the targeted member-specific goals. Based on national standards for CM practice, the RN CM focuses on empowering the member to support optimal maternal-fetal wellness and improved self-management.
Key Responsibilities/Duties – what you will be doing
- Perform telephonic member outreach and/or face-to-face encounter utilizing key motivational interviewing skills to facilitate program enrollment. Perform departmental assessments and evaluate member holistically to identify needs, health goals, and barriers to wellness. Through assessment and collaboration with member/caregiver and providers, develop a member-specific plan of care, implement member-specific care manager interventions, and revise plan of care as needed. Complete documentation in applicable platform according to departmental policy and regulatory standards.
- Provide targeted health education, proactive strategies for condition management, and communication with key providers and vendors actively involved in the member's care.
- Collaborate with member/caregiver and the facility care team to coordinate a safe transition to the next level of care, which includes but is not limited to ensure understanding post-hospital discharge instructions, facilitate needed services and follow-up, and implement strategies to prevent re-admission.
- Collaborates and liaises with the interdisciplinary care team, to improve member outcomes (i.e., Utilization Management, Medical Director, pharmacy, community health workers, dementia care specialists, wellness, and Behavioral Health CM). Attending and presenting (as appropriate) high risk members at interdisciplinary rounds forum.
- Maintain professional growth and development through self-directed learning activities.
Qualifications – what you need to perform the job
Certification and Licensure
- Registered Nurse with current unrestricted license in state of residence
- May be required to obtain other state licensure in states where Point32Health operates
- Understand and follow the provisions of state-specific Nurse Practice Act(s) where Point32Health operates
- National certification in Case Management desirable
Education
- Required (minimum): Bachelor's degree or relevant equivalent experience
- Preferred: Bachelor's degree in nursing
Experience
- Required (minimum): 5 years' relevant clinical experience
- Preferred: Experience in home care or case management.
- Proficiency in a second language desirable.
- Experience in specialty areas a plus.
Skill Requirements
- Skill and proficiency in Microsoft applications, technical concepts and principles; computer software applications
- Work cooperatively as a team member across multiple levels within the organization
- Skilled in assessment, planning, and managing member care
- Advanced communication and interpersonal skills
- Independent and autonomous with key job functions
- Ability to address multiple complex issues
- Flexibility and adaptability to changing healthcare environment
- Ability to organize and prioritize work and member needs
- Demonstration of strong clinical and critical thinking skills
- Regard for confidential data and adherence to corporate compliance policy
Working Conditions and Additional Requirements (include special requirements, e.g., lifting, travel):
- Must be able to work under normal office conditions and work from remote office as required.
- Work may require simultaneous use of a telephone/headset and PC/keyboard and sitting for extended durations.
- Ability to make face to face visits (member home, provider practices, facilities) as needed to meet the member needs and produce positive outcomes
- Valid Driver's license and vehicle in good working condition as travel is required
- May be required to work additional hours beyond standard work schedule.
- Other duties as assigned and needed by the department
Salary Range
$87,128.40 -$130,692.60