Hybrid Case Manager, Maternity

at E-Verify Program

• Job title: Case Manager, Maternity
• Job type: Full Time
• Experience level: Mid level, Senior
• Salary: $73,698 - $117,917 per year
• Degree requirement: Professional Certificate
• Location requirements: Hybrid, United States

About the role

• Case Manager coordinating care and resources for member populations, ensuring optimal clinical and resource outcomes. Join a leading health insurance provider dedicated to community health improvement.

Responsibilities

• Serve as a team member on a multidisciplinary team, coordinating care, resources and/or services for members to achieve optimal clinical and resource outcomes.
• Utilize applicable clinical skillset and perform comprehensive assessments to determine how to best collaborate with members, family, internal partners and external services/providers on plans for treatment, appropriate intervention and/or discharge planning.
• Develop a member-centric plan tailored to members’ needs, health status, educational status and level of support needs; identify barriers to meeting goals or plan of care
• Utilize community resources and funding sources as needed in the development of the plan of care.
• Perform ongoing monitoring and management of member which may include scheduled follow-up with member, discussion of plan with member, appropriate services/education to address needs, appropriate referrals with supporting documentation, assessment of progress towards goals, modification of plan/goals as needed, with contact frequency appropriate to member acuity.
• Evaluate and facilitate care provided to members through the continuum of care (physician office, hospital, rehabilitation unit, skilled nursing facility, home care, etc).
• Educate members and encourage pro-active intervention to limit expense and encourage positive outcomes
• Effectively document all aspects of the plan from the initial assessment, development of the plan, implementation, monitoring, and evaluating outcome.
• May outreach directly to members identified as high risk, high cost, or high utilization cases.
• May review alternative treatment plans for case management candidates and assess available benefits and the need for benefits exception or flex benefit options, where eligible.
• May evaluate medical necessity and appropriateness of services as defined by department.
• As needed, develop relevant policies/procedures, education or training for use both internally and externally.

Requirements

• RN with 3 years of clinical and/or case management experience required
• Must have and maintain a valid and applicable clinical license (NC or compact multi-state licensure) to perform described job duties
• For some roles, additional specialty certification (i.e. CCM, CDCES) may be required. If so, incumbents must obtain relevant certification within 2 years of employment

Benefits

• Medical, dental, and vision coverage along with numerous health and wellness programs
• Parental leave and support plus adoption and surrogacy assistance
• Career development programs and tuition reimbursement for continued education
• 401k match including an annual company contribution
• Work-life balance, flexibility, and the autonomy to do great work