Nurse Case Manager - Maternity (must reside in KY)

Company

ProgenyHealth is a leading provider of care management solutions for premature and medically complex newborns positively impacting maternal and infant health outcomes across America. Our program builds a network of support for an uninterrupted continuum of care from prenatal health, through any resultant NICU stay, and all the way to one full year of life. Our team of neonatologists, pediatricians, and NICU nurses provide continuity of care in collaboration with providers from hospital to caregivers at home and throughout the first year of life. We help overcome systemic barriers to support healthier pregnancies and healthier starts to life for all moms and babies, one family at a time.

Job Role

The Case Manager will focus on empowering the members’ family to support optimal wellness while advocating for the necessary medical services across the health care continuum. The Case Manager works in a telephonic managed care setting combining strong clinical knowledge and critical thinking to facilitate a plan of care that will ensure quality medical care for the high-risk member population serviced by ProgenyHealth Inc. based on the CMSA national standards for case management practice.

· Must reside in Kentucky. 

· Assesses the physical, functional, psychological, environmental, educational, and financial needs of members referred to the Case Management program.

· Completes needs assessments for all members in CM and develops care plans individualized to the needs of each member as per ProgenyHealth policies and procedures.

· Assigns risk stratification based on complexity of medical and social needs and determines ongoing frequency of calls to continually assess plan of care.

· Monitors the care plan to ensure effective, appropriate provision of services and adequacy of benefits.

· Interfaces with providers to assist with care coordination activities, which can include appointments, transportation, DME, etc.

· Provides education to members regarding condition, treatment plan, benefits, services, and how to access needed care.

· Monitors ongoing progress towards goal achievement and reassess changes in health status throughout continuum of care.

· Provides referrals to appropriate community resources; facilitates access and communication when multiple services are involved; monitors activities to ensure that services are actually being delivered and meeting the needs of the member.

· Participates in interdisciplinary and client rounds with pertinent health care team members to identify, clarify, and/or prevent risk, quality, or plan of care variances.

Qualifications

· Registered Nurse (RN) with a current, unrestricted license is required. 

· College degree is preferred.

· Experience in a Case Management role is preferred.

· Previous experience in a maternity management program preferred. 

· Three or more years of clinical experience in OB/L&D or related area is required.

· CCM certification required within the timeframe specified by company policy.

· Experience with data entry into a database or EHR required. Must be computer literate.

· Excellent communication skills and organizational ability are required. Must be self-motivated and willing to learn multiple tasks. · ·Must be well organized and able to prioritize tasks.

· Must demonstrate accuracy in spelling and documentation.

· Demonstrated strength in working independently as well as collaboratively within a team.

· Must have excellent interpersonal skills, telephone etiquette, and maintain positive communication at all times.

· Must have commitment to excellence in customer service.

Benefits

Some of the benefits we offer our team are:

• Paid Time Off
• Paid Parental Leave
• Medical, dental, vision benefits
• 401K with company match
• Short- and Long-Term Disability
• Group Life Insurance
• Tuition reimbursement
• Professional development opportunities
• Business Casual work environment