OB Care Manager

Maryland Care Management Inc•Linthicum, MD

1d•Hybrid

About The Position

This position is responsible for the planning, development, implementation, and timely oversight of care plans for members with identified Care Management (CM) needs. The incumbent is responsible for managing the care care management process as defined by improving coordination, continuity, accessibility, and appropriate utilization of health care services and community resources for high risk and special needs members. Maryland Care Management, Inc. (MCMI) manages Maryland Physician Care's (MPC) statewide provider network of hospitals and physicians. Maryland Physicians Care has been providing services to the HealthChoice Medicaid populations since 1996, and we are proud of our footprint in the community. With over 230,000 members, MPC consistently has been one of MD's largest Medicaid-managed care organizations.

Requirements

The ability to successfully utilize Microsoft Office suite and common computer and office hardware is necessary.
Ability to perform mathematical skills and simple stats accurately.
Ability to conduct presentations and training before small and large groups.
Knowledge of the American with Disabilities Act of 1990.
Demonstrated skill in written and oral communication including presentations and training before small and large groups.
Registered Nurse with current state license (in good standing)
2+ years of clinical nursing experience in an acute care or community setting
2+ years OB/GYN experience
Experience assisting members using community agencies

Nice To Haves

2 years of managed care experience preferred
CCM/BSN preferred

Responsibilities

Assists in developing, maintaining, and monitoring processes to promote the timely identification and assessment of high risk and special needs members.
Serves as an interdisciplinary team member in management of identified members, performing clinical/social determinants of health assessments and in collaboration with physicians, determining medical needs.
Conducts telephone or face-to-face interviews of members to identify risk factors and the need for care management.
Fosters professional networks and relationships with service and resource providers to promote continuity and quality of care for members.
Initiates, develops, plans, and implements care plans designed to promote the delivery of quality care and service to members with identified CM needs.
Utilizes clinical judgment to discharge members from care management according to plan policies and procedures.
Maintains care management records according to plan policies and procedures and ensures data integrity in health plan information systems.
Educates members' medical providers regarding the members' special needs to ensure consideration to the unique needs of the patients in treatment planning.
Coordinates and communicates with community support and social service systems for members.
Following HIPAA guidelines, the Care Manager maintains confidentiality of patient information and adheres to appropriate release of medical information procedures.
Identifies and reports gaps in the service delivery system.