Maternity Care Manager

For roles that are 100% hybrid, you must have access to a reliable high-speed internet connection to support daily job responsibilities. A minimum bandwidth of 50 Mbps download and 5 Mbps upload is required. Those fully remote associates residing in states where service is required by contract, law, or regulation will be allowed to submit for reimbursement.

Headquartered in Newtown Square, Pennsylvania, AmeriHealth Caritas is a mission-driven organization with over 30 years of experience. We deliver comprehensive, outcomes-driven care to those who need it most. We offer integrated managed care products, pharmaceutical benefit management and specialty pharmacy services, behavioral health services, and other administrative services.

Role Overview

The Maternity Care Manager assists members appropriate for care management and care coordination services in achieving their optimal level of health through self-management. The Maternity Care Manager is responsible for engaging the member, member's caregiver and providers to assess, plan, and establish individual member goals. Will facilitate and coordinate care for the members while assuring quality and use of cost-effective resources. The position will function as a single point of contact and be an advocate for members in the care management program. In addition, the Maternity Care Manager will participate in meetings in collaboration with the DC Strong Start Early Intervention Program.

Work Arrangement

• Monday through Friday, 8:30 AM EST to 5:00 PM EST
• 4 out of 5 days a week must be worked at our DC office located at 1201 Maine SW
• Must reside in the DC metro area. Office is in close proximity to two metro stations.
• Must engage directly with identified members through face-to-face visits in the community as needed.

Responsibilities

• Assess members through face-to-face or telephone calls to determine care coordination and care management needs for all referred members
• Completes a comprehensive person-centered assessment that includes physical health history, mental health history, social determinants of health, and supportive needs
• Coordinates physical, behavioral health, and social services
• Provides medication management, including regular medication reconciliation and support of medication adherence
• Identifies problems/barriers for care coordination and appropriate care management interventions
• Creates a plan of care to assist members in reducing/resolving problems and/or barriers so that members may achieve their optimal level of health
• Identifies goals and assigns priority with associated time frames for completion. As appropriate, shares goals with the member and family
• Identifies and implements the appropriate level of intervention based upon the member’s needs and clinical progress
• Schedules follow up calls as necessary, makes appropriate referrals. Implements actions to address member issues. Documents progress towards meeting goals and resolving problems
• Coordinates care and services with the Care Coordinator, Community Health Navigator, member, member's caregiver as appropriate, PCP, Specialist, DC OSSE Strong Start Program, and Facility/Vendor Providers
• Participate in regularly scheduled meetings with the DC Strong Start Early Intervention Program

Education and Experience

• Associate’s Degree in Nursing
• Minimum of 3 years of independent clinical practice experience in High Risk Ante/Post-Partum and/or mother-baby in acute care, community setting, or homecare
• Minimum of 1 year of case management experience supporting Medicaid members within a managed care organization preferred

Licensure

• Active and unencumbered RN license in the District of Columbia
• Valid driver's license with car insurance is required

Skills & Abilities

• Proficiency in MS Office (Word, Excel, Outlook, Teams), internet applications, and electronic medical record/documentation systems is essential

Flexible work solutions including remote options, hybrid work schedules, Competitive pay, Paid time off including holidays and volunteer events, Health insurance coverage for you and your dependents on Day 1, 401(k) Tuition reimbursement and more.