Maternal Care Management Coordinator

Blue Cross & Blue Shield of Mississippi • Flowood, MS

1d

About The Position

Healthy Careers Start Here At Blue Cross & Blue Shield of Mississippi, we encourage professional growth in a challenging and fast-paced atmosphere. Our 'be healthy' culture promotes health and wellness at all levels of the Company, and we provide our employees with the time, tools and resources to commit to a healthy lifestyle. 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 and RN licensure that is unrestricted in the state of Mississippi required.
• At least three years of recent maternal health clinical experience is required.
• Excellent clinical thinking skills required.
• Excellent oral/written communication skills are required.
• Must have excellent organizational skills to successfully prioritize tasks and to ensure deadlines and benchmarks are consistently met.
• Must be able to work a flexible schedule when required.
• Must have above average PC skills and intermediate knowledge of Microsoft Office.

Nice To Haves

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

Responsibilities

• Provide individualized, expert clinical support to high-risk pregnant Members, helping them navigate the complexities of their prenatal, antenatal, and postpartum journey.
• 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.
• 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.
• Function within a broader internal multidisciplinary health management team to include clinical pharmacists, health and wellness coaches, Medical Director and others.
• Serve as a point of contact and Member advocate, working to identify gaps in care and eliminate barriers to timely, best practice-supported care.
• Use established criteria to determine if hospital, outpatient, or home services are medically necessary and supported by evidence based, best practice guidelines.
• 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.
• 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.

Benefits

• We offer a comprehensive benefits package that is worth approximately one-third of the salary compensation.
• Our benefits program is among the best in the health care field.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level