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Maternity Case Manager RN
2 months ago
Job Summary:
The Maternity Case Manager RN will work collaboratively to promote quality care and cost-effective outcomes that enhance the physical, psychosocial, and vocational health of plan participants. This role will work within the policies and procedures of Lucent Health and according to the Practice Guidelines accepted by the profession of case management.
Responsibilities:
- Assessment:
- Define role and scope of activities to the patient in a comprehensible manner.
- Communicate to the patient that the information gathered will be shared with the payer.
- Gather consent for case management activities.
- Determine individual needs based on an assessment that identifies all significant needs related to the medical condition and care, psychosocial condition and care, vocational situation, payer issues, available community resources, and barriers to effective outcomes.
- Work in a holistic manner, considering both medical and psychosocial issues.
- Identify issues that might interfere with the provision of the highest quality, most appropriate, cost-effective care.
- Keep in mind that a thorough, objective assessment is necessary to a successful outcome.
- Planning and Coordination:
- Create an individualized plan of action based on the assessment which facilitates the coordination of appropriate and necessary treatment and services required by the patient.
- Give consideration, in developing the plan, to the benefit plan design/coverage options. Set appropriate, measurable goals.
- Provide the patient with information to make informed decisions, empowering and encouraging the patient to make his own decisions through including him in the planning process.
- Develop contingency plans.
- Facilitate communication of the patient's wishes to all members of the healthcare team.
- When appropriate, discuss advanced directives.
- Obtain the acceptance of all parties (patient, family, payer, and providers) prior to instituting the plan.
- Develop a plan which advocates for the patient and maximizes benefit dollars.
- Research and include costs of services and use of community resources in plan design.
- Implementation and Monitoring:
- Implement a plan that is based on the assessment. Skillfully negotiate and coordinate care based on the plan developed.
- Identify and coordinate resources to ensure success of the plan.
- Work within the plan network as possible. Refer to only those providers that are familiar or researched to ensure high quality.
- Monitor the provision of the coordinated plan.
- Review the care plan for compliance with standards of care and coordinates physician review when needed of procedures, medications, and care plans to ensure that services are medically necessary and consistent with care standards and health plan language.
- Appropriately communicate the outcome of medical necessity reviews per policy.
- Evaluation:
- Evaluate plan on a regular basis to determine effectiveness, patient satisfaction, provider comfort, payer satisfaction, if the plan is meeting the needs of all involved parties (but most particularly-the patient's needs) cost effectiveness, patient compliance with treatment, and the impact on the patient's quality of life.
- Determine if revisions are required due to changes in medical condition, family status, insurance coverage, etc.
- Maintain availability and willingness to revise the plan as needed.
- Continue involvement as active, effective case manager.
Requirements:
- Active, unrestricted RN license in the state(s) of practice - Multi-State license required.
- Current certified case manager (CCM) credential preferred.
- A minimum of three (3) years of clinical experience in maternity telephonic case management, facility case management or nurse navigator experience. Preferred clinical experience in bedside maternity nursing environment.
- Ability to multi-task including navigation of multiple systems, multiple monitors, and have a conversation via telephone simultaneously.
- Excellent time management and organizational skills, with the ability to maintain flexibility and work independently.
Equal Employment Opportunity Policy Statement:
Llucent Health is an Equal Opportunity Employer that does not discriminate based on actual or perceived race, color, creed, religion, alienage or national origin, ancestry, citizenship status, age, sex or gender (including pregnancy, childbirth and related medical conditions), gender identity, gender expression, transgender status, sexual orientation, marital status, military service and veteran status.
