[Hiring] RN Maternity Case Manager @WebTPA

Role Description

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.

What Will You Be Doing:

• Maternity Case Management process includes assessing the member’s health status and care coordination needs.
• Contact with patient, family, physicians, additional health care providers, and community resources.
• Identification of alternative treatment plans, which would have to be approved by all parties.
• Monitor the health status and the impact of the treatment plan for each member.
• Identification of services, resources, providers, and facilities that could best serve members in a timely and cost-effective manner.
• Development and implementation of 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.
• Accurate and timely reporting as deemed appropriate by each client.
• Interpreting individual health plans and authorizing/coordinating care in accordance with plan provisions.

Qualifications

• 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.

Requirements

• (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.

Benefits

• Sedentary work: Exerting up to 10 pounds of force occasionally to move objects.
• Must be able to travel to multiple locations for work (i.e. travel to attend meetings, events, conferences).