Clinical - Care Manager (Rn) - J01007

OverviewPosition 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/ExperienceRequires a Degree from an Accredited School of Nursing or a Bachelor's degree in Nursing and 2 – 4 years of related experience.License/CertificationRN - Registered Nurse - State Licensure and/or Compact State Licensure required.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 needsIdentifies problems/barriers to care and provide appropriate care management interventionsCoordinates between the member and/or family/caregivers and the care provider team to ensure members are receiving adequate and appropriate person-centered care or servicesProvides ongoing follow up and monitoring of member status, change in condition, and progress towards care plan / service plan goals; collaborates with member, caregivers, and appropriate providers to revise or update care plan / service plan as necessaryProvides resource support to members and care managers for local resources for various services based on service assessment and plans, as appropriateFacilitates care management and collaborates with appropriate providers or specialists to ensure timely access to needed care or servicesMay perform telephonic, digital, home and/or other site outreach to assess member needs and collaborate with resourcesCollects, documents, and maintains all member information and care management activities to ensure compliance with current state, federal, and third-party payer regulatorsProvides and/or facilitates education to members and their families/caregivers on disease processes, resolving care gaps, healthcare provider instructions, care options, referrals, and healthcare benefitsProvides feedback to leadership on opportunities to improve and enhance care and quality delivery for members in a cost-effective mannerOther duties or responsibilities as assigned by people leader to meet business needsPerforms other duties as assignedComplies with all policies and standardsEEO"Mindlance is an Equal Opportunity Employer and does not discriminate in employment on the basis of – Minority/Gender/Disability/Religion/LGBTQI/Age/Veterans."Story Behind the NeedWe 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 RoleWalk 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 and NICU babies.This CM will receive 2-4 referrals per day for outreach and will include both pregnant members any trimester and NICU babies.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.Caseload is approximately ***** members with 20% of those cases being complex.The care managers average 13 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.Member facing, not provider facing.First Day Plan:The care manager will work on getting their computer set up and will work with IT in order to do this.Once in the computer, the care manager will meet with their new leader for next steps.Some new hires will start on trainings while others will go with a preceptor their first day.On day three this individual will be going into Learning Journey for 3 1/2 weeks.Previous job titles/background for this role:A RN with experience in OB, labor and delivery, and/or NICU experience.Candidate Requirements:A RN with experience in OB, labor and delivery, and/or NICU experience.Education/CertificationRequired: MO RN license (no other license will be accepted) Preferred: LicensureRequired: RN; Preferred: 3-5+ years of experience.Labor and delivery experience a must.Disqualifiers:Additional qualities to look for:Top 3 must-have hard skills stack-ranked by importance1) Multi-tasker (ability to type and talk), tech savvy2) Works independently3) Good communication/Good people skills#J-*****-Ljbffr