Maternal Care Management Coordinator, RN

Blue Cross & Blue Shield of Mississippi•Flowood, MS

About The Position

The Maternal Care Management Coordinator is responsible for working with high-risk pregnant Members to provide individualized, expert clinical support, helping them navigate the complexities of their prenatal, antenatal, and postpartum journey. The incumbent will conduct thorough clinical and behavioral assessments to fully understand the Member’s health status, progress of disease states and/or treatment plan, and identify issues that could impact the Member’s care. The Maternal Care Management Coordinator will work with the Provider and Member utilizing a multi-disciplinary approach through discharge planning, facilitation of an appropriate treatment plan, Member education, and coordination of care needs to ensure desired outcomes are achieved for quality and cost-effective maternal and infant care. They will also function within a broader internal multidisciplinary health management team to include clinical pharmacists, health and wellness coaches, Medical Director and others. The incumbent will serve as a point of contact and Member advocate, working to identify gaps in care and eliminate barriers to timely, best practice-supported care. The Maternal Care Management Coordinator is responsible for using established criteria to determine if hospital, outpatient, or home services are medically necessary and supported by evidence based, best practice guidelines. The incumbent will participate in Care Conferences as needed with the clinical teams to ensure multi-disciplinary reviews of high-risk cases for facilitation of appropriate action plans and referrals for Quality Management review if applicable. The Maternal Care Management Coordinator will remain up-to-date with evidence-based best practice guidelines for maternal and infant health and utilize this information to align care coordination efforts and inform the Company’s existing value-based quality initiatives.

Requirements

Bachelor’s degree in Nursing
RN licensure that is unrestricted in the state of Mississippi
At least three years of recent maternal health clinical experience
Excellent clinical thinking skills
Excellent oral/written communication skills
Excellent organizational skills to prioritize tasks and meet deadlines
Ability to work a flexible schedule when required
Above average PC skills
Intermediate knowledge of Microsoft Office

Nice To Haves

Certified Case Manager (CCM®) certification
Must obtain CCM certification within 2 years of hire if not certified upon hire

Responsibilities

Conduct thorough clinical and behavioral assessments to understand Member's health status, disease progression, and treatment plan.
Identify issues impacting Member's care and work with Providers and Members to develop appropriate treatment plans.
Facilitate discharge planning, Member education, and coordination of care needs for maternal and infant care.
Collaborate with internal multidisciplinary health management team (clinical pharmacists, health coaches, Medical Director, etc.).
Serve as a point of contact and Member advocate, identifying gaps in care and eliminating barriers to care.
Determine medical necessity of services using established criteria and evidence-based guidelines.
Participate in Care Conferences for multi-disciplinary reviews of high-risk cases.
Refer cases for Quality Management review when applicable.
Stay updated on evidence-based best practice guidelines for maternal and infant health.
Align care coordination efforts with Company's value-based quality initiatives.