Integrated Nurse Case Manager, RN Maternity/OBGYN

Description:Responsible for case management services within the scope of licensure; develops, monitors, evaluates, and revises the member's care plan to meet the member's needs, with the goal of optimizing member health care across the care continuumPerforms telephonic or face-to-face clinical assessments for the identification, evaluation, coordination and management of member's needs, including physical and behavioral health, social services and long-term servicesIdentifies members for high-risk complications and coordinates care in conjunction with the member and health care teamManages chronic illnesses, co-morbidities, and/or disabilities ensuring cost effective and efficient utilization of health benefits; conducts gap in care management for quality programsAssists with the implementation of member care plans by facilitating authorizations/referrals within benefits structure or extra-contractual arrangements, as permissibleInterfaces with Medical Directors, Physician Advisors and/or Inter-Disciplinary Teams on care management treatment plansPresents cases at case conferences for multidisciplinary focusEnsures compliance with regulatory, accrediting and company policies and proceduresMay assist in problem solving with provider, claims or service issuesRequirements:Associate or Bachelors Degree in Nursing REQUIREDRegistered Nurse (RN) License (Compact or Virginia) REQUIRED3 years experience in Nursing REQUIREDCase Management experience preferredManaged Care or Health Plan experience preferredExperience in Maternity/OB/Labor & Delivery/Mother Baby/Postpartum/Pregnant population preferredStrong knowledge of physical, psychological, socio-cultural, and cognitive patient needsExcellent communication skills, both oral and writtenStrong problem-solving and analytical skillsAbility to perform telephonic or face-to-face clinical assessmentsAbility to work standard hours 8am to 5pm EST, Monday-Friday (40 hours/week)Must be located in and eligible to work remotely in VirginiaBenefits:Medical, Dental, Vision plansAdoption, Fertility and Surrogacy Reimbursement up to $10,000Paid Time Off and Sick LeavePaid Parental & Family Caregiver LeaveEmergency Backup CareLong-Term, Short-Term Disability, and Critical Illness plansLife Insurance401k/403B with Employer MatchTuition Assistance $5,250/year and discounted educational opportunities through Guild EducationStudent Debt Pay Down $10,000Reimbursement for certifications and free access to complete CEUs and professional developmentPet InsuranceLegal Resources PlanOpportunity to earn an annual discretionary bonus if eligibility criteria are metFamily-friendly culture, community involvement, and professional development opportunities Apply tot his job