Mom & Baby Care Manager

Job Description: • Collaborates with members of an inter-disciplinary care team (ICT), providers, community and faith-based organizations to improve quality and meet the needs of the individual, natural supports and the population with culturally competent delivery of care, services and supports • Facilitates communication, coordinates care and service of the member through assessments, identification, person-centered planning, assist the member in creation and evaluation of person-centered care plans • Engage the member and their natural support system through strength-based assessments and a trauma-informed care approach using motivation interviewing • Facilitate regularly scheduled inter-disciplinary care team (ICT) meetings to meet the needs of the member • Develop and regularly update a person-centered individualized care plan (ICP) in collaboration with the ICT • Identify and manage barriers to achievement of care plan goals • Assist with empowering the member to manage and improve their health, wellness, safety, adaptation, and self-care through effective care coordination and case management • Facilitate coordination, communication and collaboration with the member the ICT in order to achieve goals and maximize positive member outcomes • Educate the member/ natural supports about treatment options, community resources, insurance benefits, etc. • Employ ongoing assessment and documentation to evaluate the member’s response to and progress on the ICP • Document care coordination activities and member response in a timely manner according to standards of practice and CareSource policies regarding professional documentation • Adherence to NCQA and CMSA standards • Perform any other job duties as requested Requirements: • Nursing degree from an accredited nursing program or Bachelor’s degree in a health care field or equivalent years of relevant work experience is required • Advanced degree associated with clinical licensure is preferred • A minimum of three (3) years of experience in nursing (i.e. discharge planning, case management, care coordination, and/or home/community health management experience) is required • Three (3) years Medicaid and/or Medicare managed care experience is preferred • Three (3) years maternity experience preferred • Strong understanding of Quality, HEDIS, disease management, supportive medication reconciliation and adherence • Intermediate proficiency level with Microsoft Office, including Outlook, Word and Excel • Knowledge of local, state & federal healthcare laws and regulations & all company policies regarding case management practices • Knowledge of and adherence to Case Management Society of America (CMSA) standards for case management practice • Current unrestricted clinical license in state of practice as a Registered Nurse is required. Licensure may be required in multiple states as applicable based on State requirement of the work assigned • Case Management Certification is highly preferred. Benefits: • bonuses tied to company and individual performance • substantial and comprehensive total rewards package Apply tot his job