RN Care Manager II - OB/NICU Team - 1162367 (22051450)
About the Company:
A Fortune 500 company, is a diversified, multi-national healthcare enterprise that provides a portfolio of services to government sponsored healthcare programs, focusing on underinsured and uninsured individuals. Many receive benefits provided under Medicaid, including the State Children's Health Insurance Program (CHIP), as well as Aged, Blind or Disabled (ABD), Foster Care and Long Term Care (LTC), in addition to other state-sponsored/hybrid programs, and Medicare (Special Needs Plans).
The Company operates local health plans and offers a range of health insurance solutions. It also contracts with other healthcare and commercial organizations to provide specialty services including behavioral health management, care management software, correctional healthcare services, dental benefits management, in-home health services, life and health management, managed vision, pharmacy benefits management, specialty pharmacy and telehealth services.
Perform care management duties to assess, plan and coordinate all aspects of medical and supporting services across the continuum of care for select members to promote quality, cost effective care.
- Assess the member's current health status, resource utilization, past and present treatment plan and services, prognosis, short and long term goals, treatment and provider options
- Utilize assessment skills and discretionary judgment to develop plan of care based upon assessment with specific objectives, goals and interventions designed to meet member's needs and promote desired outcomes
- Coordinate services between Primary Care Physician (PCP), specialists, medical providers, and non-medical staff as necessary to meet the complete medical socio economic needs of clients
- Provide patient and provider education
- Facilitate member access to community based services
- Monitor referrals made to community based organizations, medical care and other services to support the members’ overall care management plan
- Actively participate in integrated team care management rounds
- Identify related risk management quality concerns and report these scenarios to the appropriate resources.
- Caseload will reflect heavier weighting of complex cases than Care Manager I, commensurate with experience
- Enter and maintain assessments, authorizations, and pertinent clinical information into various medical management systems
- Direct care to participating network providers
- Perform duties independently, demonstrating advanced understanding of complex care management principles.
- Participate in case management committees and work on special projects related to case management as needed
The company offers more than just medical insurance. They pay most of your benefits costs and in some cases – they pay 100 percent. Most of the benefits not covered by the company are paid with pre-tax payroll deductions.
- Health insurance
- Dental insurance
- Vision insurance
- Flexible spending accounts (includes health care, dependent care mass transit reimbursement)
- Short- and long-term disability insurance
- Basic Life insurance
- Supplemental AD&D
- Supplemental life insurance
- Wellness Program
- 401(k) retirement with company match
- Employee stock purchase plan
- Vacation, Personal and Sick time
- Paid Company Holidays
- Employee Assistance Program (EAP)
- Training and Learning Opportunities
- Tuition Reimbursement/Educational Assistance
- Service Awards
- On-site fitness center or discount at local fitness centers (most locations)
- Discounts for select local and national products and services, including cell phones, computers and more
- Other amenities may be available, but vary by location
- Graduate from an Accredited School of Nursing. Bachelor’s degree in Nursing preferred.
- 2+ years of clinical nursing experience in a clinical, acute care, or community setting .
- 1+ years of case management experience in a managed care setting.
- Knowledge of utilization management principles and healthcare managed care.
- Experience with medical decision support tools ([link removed], NCCN) and government sponsored managed care programs.
- Clinical OB/NICU RN experience highly preferred
- Wisconsin RN license.