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Prenatal Case Manager

Remote:

Full Remote

Contract:

Full time

Experience:

Mid-level (2-5 years)

Work from:

United States

Offer summary

Qualifications:

Current unrestricted North Carolina nursing license, 3 years clinical perinatal experience.

Key responsabilities:

Explain the prenatal program and its components
Evaluate patient data and risk factors
Provide individualized teaching on pregnancy
Document all prenatal interactions accurately
Assist with scheduling appointments and case management tasks

MedCost LLC Insurance SME https://www.medcost.com/

201 - 500 Employees

See more MedCost LLC offers

Job description

Position Summary:

Under the direction of the Manager of Care Management, the Prenatal Case Manager administers the SmartStarts maternity management program. Prenatal Case Managers collects clinical information, provides risk stratification, and educates pregnant patients. The Prenatal Case Manager must maintain a current, unrestricted, and valid nursing license in the state of North Carolina

Position Responsibilities:

Explain the prenatal program; including confidentiality, GINA and incentives/disincentives where they apply.
Contact patient at scheduled time and review initial assessment. Review personal, family, OB, and current history. Document pertinent lab results, medications, and discomforts.
Evaluate information, claims history, MARA risk score and gaps in care.
Evaluate system generated risk stratification in assessment. Make adjustments as necessary based on patient information.
Provide individualized patient teaching regarding pregnancy process based on identified risk factors. Document in patient record.
Assess patients for postpartum depression using depression tool and provide support as necessary.
Document maternal and infant outcomes.
Verify written educational materials are sent to support verbal teaching.
Refer patients to company and community resources based on needs.
Communicate with the patient’s physician as necessary. Provide teaching regarding treatments and intervene on behalf of patient as necessary.
Document all prenatal calls in patient record.
Schedule appointments at times convenient for the patient and nurse using prescribed scheduling guidelines. Update schedule availability to reflect vacation, lunch and meetings.
Follow assigned caseload.
Promptly answer incoming emails and care manager messages.
In the event of an absence, assist with making or rescheduling calls as time allows.
Provide Case Management for catastrophic prenatal patients.
Document potential savings for all appropriate patients.
Document within care plan for all patients.
Communicate program completion for accurate incentive administration.
Identify potential testimonials and document Case Stories for potential marketing materials.
Act as a resource to both Utilization Review and Case Management for medical necessity and case management needs.
Assist Utilization Review, PCM or Transitional Care when caseload allows
Complete special projects or duties assigned by the Manager, Care Management.

Please note this job description is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities that are required of the employee for this job. Duties, responsibilities and activities may change at any time with or without notice.

Position Qualifications:

Required

Nurse with current and unrestricted North Carolina nursing license
3 years recent clinical perinatal experience/ or equivalent professional experience

Skills, Knowledge And Abilities

Excellent oral and written communication skills
Exceptional customer service, and interpersonal skills
Effective problem-solving and influencing skills
Strong organizational, self-motivation, and decision-making skills
Basic Computer Skills
Ability to manage multiple priorities in a fast-paced environment
Ability to work independently and collaboratively, as needed
Ability to work 6-8 hours outside normal working hours of 8:30-5:00.

Key Competencies

Service orientation
Integrity
Ethical practice and confidentiality

MedCost provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws. This policy applies to all terms and conditions of employment, including recruiting, hiring, placement, promotion, termination, layoff, recall, transfer, leaves of absence, compensation and training.

MedCost participates in the Electronic Verification system (E-Verify) to electronically verify the work authorization of newly-hired employees. E-Verify is an internet-based program that compares information from an employee's Form I-9 to data contained in the federal records of the Social Security Administration and the Department of Homeland Security to confirm employment eligibility. MedCost does not use E-Verify to pre-screen job applicants.