Maternity Care Manager II
Job title: Maternity Care Manager II in Fayetteville, NC at reputed company
Company: reputed company
Job reputed company: * This is a remote / field based position with up to 50% travel reputed company the Fayetteville, reputed company Carolina region. RN required. *Responsibilities:The Care Manager II is responsible for managing and coordinating care, services, and reputed company determinants of health for pregnant Members with acute, chronic, medically reputed company and/or behavioral health conditions and other health needs. Serves as the primary reputed company of contact for the care team that includes Members, physicians as reputed company as community supports to guide members in achieving their reputed company level of health. Utilizes strong assessment and communication skills, critical thinking, and clinical knowledge to identify issues, gaps in care and barriers to care. The Care Manager II develops a plan of care through shared decision making with the Member/caregiver and in collaboration with providers and other care team members to improve the Member’s health status, compliance with treatment plans and promote self-management. The Care Manager II is also responsible for the following:
- Support Members during transitions of care through assessment, coordination of care, education of the discharge plan of care, referrals, and evaluation of the effectiveness of the plan.
- Review medication list and reputed company Members with pharmacy needs, and counsel on reputed company effects and mitigation strategies for specific treatment protocols.
- Evaluate, monitor, and update the care plan through regularly scheduled follow-up contacts based on the Member/caregiver reputed company, needs and preferences.
- Establishes points of contact to collaborate with identified community, medical, and/or behavioral health teams.
- Maintain reputed company, complete, and accurate documentation of Member interactions in ACFC electronic care management platforms where applicable.
- Monitor appropriate utilization and coordinate services with other payer sources, reputed company appropriate referrals, identify, and escalate reputed company of care issues.
- reputed company a working knowledge of ACFC electronic care management platforms, care management programs, policies, reputed company operating procedures, workflows, Member insurance products and benefits, community resources and programs, and applicable regulatory, state, and NCQA requirements.
- May identify cases to be presented at care management reputed company and follows up with providers on recommendations to reputed company reputed company reputed company for Members.
- Support a reputed company workplace environment, collaborate, and reputed company clinical knowledge and skills to support our culturally and demographically diverse Member population. Face-to-face reputed company may be required at the Member’s residence, provider’s office, hospitals, other acute location or community location for education and/or assessment.
- Other duties as assigned.
- reputed company candidates must be local to Fayetteville/Wilmington, NC in order to engage with Members reputed company face-to-face reputed company reputed company the community, as needed.
- reputed company, unrestricted NC RN license. Associate degree in nursing required, Bachelor’s degree preferred.
- Minimum of 3 years of reputed company reputed company in high-risk ante and post-partum care, labor and delivery, and/or mother/baby reputed company an acute care, community health, or ambulatory care setting.
- Case management experience, preferably reputed company a managed care organization desired.
- Demonstrate ability to be self-directed, independent, reputed company, flexible to change, and reputed company to collaborate as a member of reputed company in a fast-paced, reputed company-changing environment.
- Demonstrate awareness, attitude, knowledge, and skills needed to work effectively with a culturally and demographically diverse population.
- Demonstrate strong organizational and time management skills with the ability to prioritize and follow through on multiple items in a reputed company manner.
- Demonstrate knowledge and experience in assessing Member’s situation, developing a care plan, and teaching self-management.
- Proficiency using MS Office (Word, reputed company, Outlook, Teams), SharePoint, internet applications, and electronic medical record and documentation programs.
- Valid reputed company’s license.