Pop Health Concierge Care Coordination RN- Medical Pediatric Pop

South Florida Community Care Network•Sunrise, FL

23h•Hybrid

About The Position

This role specifically serves pediatric members. Applicants must have 2 years prior experience working with pediatric populations to be considered. The Population Health and Care Coordinator for Maternal Child Health plays a critical role as a core member of the care team, working closely with medical providers, maternal health specialists, and the broader care coordination team. This position is dedicated to overseeing the maternal child health population, coordinating, and supporting the physical and mental health care of enrollees within this population across various lines of business, including managed care contract programs. The coordinator’s primary responsibilities include managing healthcare interventions across the continuum of care, from complex medical needs to routine and preventative care, with a strong focus on improving maternal/child outcomes. This includes efforts to reduce unnecessary primary C-section rates, lower NICU admission rates, and decrease NICU stay durations. The role emphasizes closing immediate care gaps, facilitating safe and appropriate levels of care, and empowering members to self-manage their health, particularly in the context of chronic condition management and maternal care. By complementing the practitioner-patient relationship and supporting the established plan of care, the coordinator utilizes cost-effective, evidence-based practice guidelines aimed at enhancing the quality of life for mothers and children. Key objectives include addressing acute needs, preventing, or delaying the progression of conditions, and reducing complications and morbidities. Ultimately, the coordinator’s work contributes to improved health outcomes, including better maternal and neonatal results, and reduced healthcare costs. All job functions are performed in accordance with the requirements of Medicaid contracts, Florida Healthy Kids (FHK) contracts, Community Care Plan (CCP) policies and procedures, and Patient-Centered Medical Home (PCMH) standards.

Requirements

Bachelor’s Degree in Nursing.
Registered Nurse licensure in the state of Florida
3-5 years of clinical experience including labor and delivery, high risk antepartum and NICU.
3-5 years of experience in a managed care, health plan, or insurance setting, particularly in maternal health or disease/case management roles.
Experience coordinating care across medical, maternal/child, and social service providers, including familiarity with utilization management processes, appeals, and authorizations.
Experience working with Medicaid, Medicare, or other state and federal health care programs, including knowledge of relevant regulations and compliance requirements.
Knowledge of Microsoft Office and internet software
Strong understanding of maternal and child health, including high-risk pregnancy management, prenatal and postnatal care, and common complications.
Knowledge of evidence-based practices and guidelines in maternal and child health, including breastfeeding promotion, nutritional assessments, and preventive screenings.
Proven ability to coordinate care across multiple providers and settings, ensuring seamless integration of services for mothers and newborns.
Experience in developing individualized care plans, monitoring progress, and adjusting care strategies as needed.
Proficient in assessing and managing the psychosocial, educational, and medical needs of pregnant members and their newborns.
Exceptional oral and written communication skills, including the ability to effectively engage and educate enrollees, families, and healthcare providers.
Strong interpersonal skills with the ability to build and maintain effective, professional relationships with enrollees, care teams, and community resources.
Ability to speak effectively before groups, including enrollees, healthcare professionals, and community stakeholders.
Demonstrated ability to assess complex situations, identify barriers to care, and develop creative solutions to improve health outcomes.
Strong analytical skills to evaluate data, track clinical outcomes, and implement care strategies that reduce risks and enhance patient care.
2 years prior experience working with pediatric populations

Nice To Haves

Master’s Degree in Nursing
Certified Case Manager
Knowledge of EPIC and/or JIVA

Responsibilities

Complete client intake on all referred or identified pregnant members across multiple lines of business, securing agreement to program participation.
Conduct initial needs assessments to evaluate medical, psychosocial, and educational needs, and ensure a risk stratification is completed to determine level of care requirements.
Develop individualized care plans that address medical, educational, and psychosocial needs, incorporating the enrollee and family in the care planning process.
Provide routine follow-up contact with enrollees and providers to ensure appointment compliance based on the level of care requirements.
Ensure enrollees have an established medical home or assist in obtaining primary healthcare for both self and newborn, if needed.
Provide care management throughout the entire pregnancy term, facilitating post-partum visits and the first well-baby examination to ensure linkage to ongoing primary care.
Create intervention and educational plans covering pregnancy knowledge, self-care behaviors, lifestyle counseling, and referral to community resources as applicable.
Develop and provide educational materials suited to enrollees' educational levels, and review these with the enrollee/caregiver and healthcare provider.
Monitor clinical outcomes, ensuring appropriately timed medical care, lab work, and self-monitoring, and assist with scheduling and compliance.
Evaluate treatment plans, referring patients to contracted providers or community organizations as appropriate.
Coordinate with community resources such as Healthy Start, WIC, SNAP, and others to support the health of the mom and newborn.
Facilitate maternity care, ensuring compliance with screening and referral for HIV, Hepatitis B, and other requirements.
Ensure obstetrical care providers offer clients Florida's Healthy Start Prenatal and Postnatal screenings in accordance with Florida Statutes.
Notify the local county health department of any pregnant enrollee testing positive for Hepatitis B and report to state and local agencies on pregnancy and births as per contractual requirements.
Coordinate with the Quality Improvement Department to collect necessary data and implement initiatives to meet or improve established benchmarks for obstetric-related quality HEDIS measures.
Maintain individual client records, ensuring compliance with Federal and State guidelines and standards, and maintain confidential medical records for each patient.
Refer to the Medical Director any questionable, quality, or inappropriate treatment regimen and/or care.
Interact with, assist, and educate physicians, hospital representatives, administrators, patients and their families, corporate representatives, and other healthcare providers regarding the High-Risk Pregnancy Management Program.
Maintain professional relationships with external agencies such as AHCA, FHK, and Community Services, serving as an ombudsman as needed.
Participate in in-service training programs to enhance professional skills and knowledge.
Assist in the coordination of services for transportation, food, shelter, finance, and mental health as identified.