RN Maternity Care Manager II, BSN (Philadelphia and Montgomery Counties in PA) at AmeriHealth Caritas

Unclassified - Philadelphia, PA

Full-time - Mid Level

Remote - Philadelphia, PA

About the position

The RN Maternity Care Manager II plays a crucial role in supporting pregnant members throughout their pregnancy journey, from prenatal care to postpartum recovery. This position is designed for a dedicated professional who will engage with members to assess their individual health needs and coordinate care effectively. The RN will serve as a single point of contact for pregnant members enrolled in the Bright Start Maternity program, ensuring they receive the necessary support and resources to achieve optimal health outcomes. In this role, the RN Maternity Care Manager II will conduct comprehensive assessments that encompass physical, psychosocial, environmental, and support needs of pregnant members. By identifying barriers to care and implementing tailored action plans, the RN will help members navigate their pregnancy challenges. The position requires the creation of personalized care plans that outline both short and long-term health goals, which will be shared with members and their families to foster collaboration and accountability. The RN will also coordinate with various healthcare providers, including OBGYNs, primary care physicians, specialists, and community organizations, to ensure a holistic approach to care. Follow-up calls and referrals will be part of the responsibilities to monitor progress and adjust care plans as necessary. This position is not only about managing health care but also about advocating for the members and ensuring they have access to the resources they need to thrive during this critical time in their lives.

Responsibilities

• Assist pregnant members in achieving optimal health throughout pregnancy, delivery, and the postpartum period.
• Engage with pregnant members and providers to assess, plan, and establish individual member goals.
• Facilitate and coordinate care for pregnant members while ensuring quality and cost-effective resource use.
• Serve as a single point of contact and advocate for pregnant members in the Bright Start Maternity program.
• Conduct comprehensive assessments of physical, psychosocial, environmental, and support needs of pregnant members.
• Identify problems/barriers and implement actions to address member issues/concerns.
• Create a plan of care to assist pregnant members in reducing/resolving problems and achieving optimal health.
• Identify both short and long-term goals and associated time frames for completion, sharing these with members and families as appropriate.
• Document progress towards meeting goals and resolving problems.
• Implement appropriate levels of intervention based on member needs and clinical progress.
• Schedule follow-up calls as necessary and make appropriate referrals.
• Coordinate care and services with members, family members, OBGYNs, PCPs, specialists, and community-based organizations.

Requirements

• Current and unrestricted Registered Nurse licensure in Pennsylvania required.
• Bachelor's Degree in Nursing required.
• Minimum of 3 years of clinical practice experience in Labor and Delivery/Mother-Baby/High Risk Ante-Post Partum.
• Minimum of 3 years of experience as a case manager, preferably providing telephonic case management.
• Case management experience within a managed care organization is preferred.
• Certification as a case manager preferred.
• Proficiency using MS Office (Word, Excel, Outlook), internet applications, and electronic medical record and documentation programs.
• Ability to meet deliverables within designated timeframes, with strong organization and communication skills.
• Valid driver's license and car insurance, and personal vehicle.

Nice-to-haves

• Experience in community outreach or attending community events supporting maternity programs.

Benefits

• Flexible work solutions including remote options and hybrid work schedules.
• Competitive pay.
• Paid time off including holidays and volunteer events.
• Health insurance coverage for you and your dependents on Day 1.
• 401(k) plan.
• Tuition reimbursement.