Maternal Care Manager

Amerihealth Caritas•Dover, DE

10d•Remote

About The Position

The Maternal Care Manager (RN/SW) supports members who may benefit from care management and care coordination services in achieving their optimal health through self-management. The role engages members, caregivers, and providers to assess needs, develop plans, and establish individual goals. It coordinates member care while promoting quality and cost-effective use of resources, and serves as a single point of contact and advocate for members in the care coordination program. The Care Manager also oversees care management activities within assigned practices to help ensure services meet Plan, NCQA, and Federal and State standards and requirements. This is a fully remote position with a Monday–Friday schedule of 8:00 a.m.–5:30 p.m. Eastern Time. Required travel within Kent County. The role requires a current, unrestricted Delaware RN license in good standing, or an unrestricted Delaware LMSW/LCSW license with experience managing medical complexities, as well as a valid driver's license. A minimum of 3–5 years of maternity, labor and delivery experience is required.

Requirements

Minimum of 3 to 5 years of experience with maternity, labor and delivery.
Current, unrestricted Delaware RN license in good standing, or unrestricted Delaware LMSW/LCSW license with experience managing medical complexities.
Valid driver's license.
Proficiency with Microsoft tools and medical record systems.
Ability to work independently and as part of a team in a fast-paced, changing environment; self-directed, adaptive, and flexible.
Ability to work effectively with a culturally and demographically diverse population.
Proficiency with MS Office (Word, Excel, Outlook, Teams), internet applications, and electronic medical record and documentation programs.
Strong organizational and time-management skills, including the ability to prioritize and follow through on multiple items promptly.
Knowledge and experience assessing member situations, developing care plans, and teaching self-management.

Nice To Haves

Ability to work with specific care teams and other engagement community partners.
Case management experience, preferably within a managed care organization.

Responsibilities

Assess members through face-to-face encounters and telephone calls to determine care coordination and care management needs.
Complete comprehensive, person-centered assessments covering physical and mental health history, social determinants of health, and supportive needs.
Coordinate physical health, behavioral health, and social services.
Provide medication management, including regular medication reconciliation and support for medication adherence.
Identify problems and barriers to care coordination and determine appropriate care management interventions.
Create plans of care to help members reduce or resolve problems and barriers, establish and prioritize goals, and set time frames for completion; share goals with members and families as appropriate.
Identify and implement the appropriate level of intervention based on member needs and clinical progress.
Schedule follow-up calls, make appropriate referrals, and take action to address member issues.
Document progress toward goals and resolution of problems in the EMR system.
Coordinate care and services with the Community Health Navigator, member and caregiver as appropriate, PCP, specialists, and facility or vendor providers.
Provide transitional care management.
Meet regularly with designated partners regarding plan-identified members and support resolution of problems and barriers so the ACDE Care Coordinator can provide high-quality care management services.
Participate in regularly scheduled meetings as needed.
Oversee care management activities within assigned practices to help ensure services meet Plan, NCQA, and Federal and State standards and requirements.