Job Profile Summary:
Position Purpose:
Develops, assesses, and facilitates complex care management activities for primarily physical needs members to provide high quality, cost-effective healthcare outcomes including personalized care plans and education for members and their families.
Education/Experience:
Requires a Degree from an Accredited School of Nursing or a Bachelor's degree in Nursing and 2 – 4 years of related experience.
License/Certification:
RN - Registered Nurse - State Licensure and/or Compact State Licensure required
For YouthCare Illinois plan only: Bachelor’s Degree and IL RN licensure required. Must reside in IL
For Sunshine Health (FL) Only: Employees supporting Florida's Children’s Medical Services (CMS) must have a minimum of two years of pediatric experience. May require up to 80% local travel required
Responsibilities:
Evaluates the needs of the member, barriers to accessing the appropriate care, social determinants of health needs, focusing on what the member identifies as priority and recommends and/or facilitates the plan for the best outcome
Develops ongoing care plans / service plans and collaborates with providers to identify providers, specialists, and/or community resources to address member's unmet needs
Identifies problems/barriers to care and provide appropriate care management interventions
Coordinates as appropriate between the member and/or family/caregivers and the care provider team to ensure members are receiving adequate and appropriate person-centered care or services
Provides ongoing follow up and monitoring of member status, change in condition, and progress towards care plan / service plan goals; collaborate with member, caregivers, and appropriate providers to revise or update care plan / service plan as necessary to meet the member's goals / unmet needs
Provides resource support to members and care managers for local resources for various services (e.g., employment, housing, participant direction, independent living, justice, foster care) based on service assessment and plans, as appropriate
Facilitate care management and collaborate with appropriate providers or specialists to ensure member has timely access to needed care or services
May perform telephonic, digital, home and/or other site outreach to assess member needs and collaborate with resources
Collects, documents, and maintains all member information and care management activities to ensure compliance with current state, federal, and third-party payer regulators
Provides and/or facilitates education to members and their families/caregivers on disease processes, resolving care gaps, healthcare provider instructions, care options, referrals, and healthcare benefits
Provides feedback to leadership on opportunities to improve and enhance care and quality delivery for members in a cost-effective manner
Other duties or responsibilities as assigned by people leader to meet business needs
Performs other duties as assigned.
Complies with all policies and standards.
EEO:
“Mindlance is an Equal Opportunity Employer and does not discriminate in employment on the basis of – Minority/Gender/Disability/Religion/LGBTQI/Age/Veterans.”
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Position Purpose:
Develops, assesses, and facilitates complex care management activities for primarily physical needs members to provide high quality, cost-effective healthcare outcomes including personalized care plans and education for members and their families.
Story Behind the Need
- What is the purpose of this team?
- Describe the surrounding team (team culture, work environment, etc.) & key projects.
- Do you have any additional upcoming hiring needs, or is this request part of a larger hiring initiative?
We are looking for an RN with experience in supporting OB/NICU. Managed care experience is a plus but not a must. The reason we outreach for OB is the intent to reduce very low birth weight babies, NICU admission and NICU length of stay. These things are mostly impacted at early interaction with the mom as early in pregnancy as possible. We’re looking for staff with experience as labor and delivery nurses, women’s health or OB clinic nurses.
Typical Day in the Role
- Walk me through the day-to-day responsibilities and a description of the project (Outside of the Workday JD).
- What are performance expectations/metrics?
- What makes this role unique?
The CM will be responsible for supporting our high risk pregnant members. This CM will receive 2-4 referrals per day for outreach and will include pregnant or postpartum members any trimester. The position will help support discharge planning and support to mom to prepare for baby being discharged. The CM will support the SSFB program and all of the initiatives for our pregnant population including timely outreach, reduction in low birth weight babies, and reduction in NICU length of stay to name a few.
The caseload is approximately 80-90 members with 20% of those cases being complex. The care managers average 15 calls per day. Audit expectation is 95%. The care manager will be provided with a template to use for their calls to help ensure all elements within the Missouri contract is being captured in the documentation.
80+ cases with 2-4 referrals a day – FAST PACE
Provider, partner & member outreach via phone & email
Applications Centene – Trucare, Omni,
Applications other - One note, word, excel, teams, outlook, copilot, one drive
Candidate Requirements: A RN with experience in OB, labor and delivery, and/or NICU experience.
Education/Certification
Required: Requires a Degree from an Accredited School of Nursing OR a Bachelor's degree in Nursing AND 2 – 4 years of related experience
Preferred:
Licensure
Required: MO RN License preferred
Preferred:
Years of experience required: 4+ years RNs with experience in OB/NICU ,
Preferred: Preferred managed care/clinic but not a requirement. WIC experience/community based .
Disqualifiers: Less than 4 years experience in related field. HOME DISTRACTIONS, must have a professional and quiet work atmosphere . Frequent job hopping (please state if contract and if completed)
Additional qualities to look for:
- Top 3 must-have hard skills stack-ranked by importance
1
Multi-tasker (ability to type and talk), FAST PACE
2
Works independently with trouble shooting skills, attention to detail for compliance is a MUST
3
Good communication written and verbal/Good people skills
Candidate Review & Selection
- Shortlisting process
- Candidate review & selection
- Interview information
- Onboard process and expectations
Projected Manager Candidate Review Date:
1-2 days post shortlisting
Type of Interviews:
Teams
Required Testing or Assessment (by Vendor):
