Case Manager, Maternity
E-Verify Program
full-time
Posted on:
Location Type: Hybrid
Location: North Carolina • South Carolina • United States
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Salary
💰 $73,698 - $117,917 per year
About the role
- 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
Applicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills & Tools
clinical assessmentscare coordinationtreatment planningdischarge planningmonitoring and managementdocumentationevaluation of carereferral managementpolicy developmentcase management
Soft Skills
communicationcollaborationproblem-solvingeducationproactive interventionorganizational skillsinterpersonal skillsadaptabilitycritical thinkingteamwork
Certifications
RN licenseCCMCDCES