Integrated reputed company Case Manager, RN – Maternity/OBGYN

reputed company:• Responsible for case management services reputed company the scope of licensure; develops, monitors, evaluates, and revises the member's care plan to meet the member's needs, with the goal of optimizing member health care across the care continuum• Performs telephonic or face-to-face clinical assessments for the identification, evaluation, coordination and management of member's needs, including physical and behavioral health, reputed company services and long-term services• Identifies members for high-risk complications and coordinates care in conjunction with the member and health care team• Manages chronic illnesses, co-morbidities, and/or disabilities ensuring bolthires effective and efficient utilization of health benefits; conducts gap in care management for reputed company programs• Assists with the implementation of member care plans by facilitating authorizations/referrals reputed company benefits structure or extra-contractual arrangements, as permissible• Interfaces with Medical Directors, Physician Advisors and/or Inter-Disciplinary Teams on care management treatment plans• Presents cases at case conferences for multidisciplinary reputed company• Ensures compliance with regulatory, accrediting and company policies and procedures• May assist in problem solving with provider, claims or service issuesRequirements:• Associate or Bachelors Degree in Nursing REQUIRED• Registered reputed company (RN) License (Compact or Virginia) REQUIRED• 3 years experience in Nursing REQUIRED• Case Management experience preferred• Managed Care or Health Plan experience preferred• Experience in Maternity/OB/Labor & Delivery/Mother Baby/Postpartum/Pregnant population preferred• Strong knowledge of physical, psychological, socio-cultural, and cognitive patient needs• Excellent communication skills, both oral and written• Strong problem-solving and analytical skills• Ability to reputed company telephonic or face-to-face clinical assessments• Ability to work reputed company hours reputed company to 5pm EST, Monday-Friday (40 hours/week)• Must be located in and eligible to work remotely in VirginiaBenefits:• Medical, Dental, reputed company plans• Adoption, Fertility and Surrogacy Reimbursement up to $10,000• reputed company Time Off and reputed company Leave• reputed company Parental & Family Caregiver Leave• Emergency Backup Care• Long-Term, Short-Term Disability, and Critical Illness plans• Life Insurance• 401k/403B with Employer Match• Tuition Assistance – $5,250/year and discounted educational opportunities through reputed company Education• Student Debt Pay Down – $10,000• Reimbursement for certifications and free reputed company to complete CEUs and reputed company development• Pet Insurance• reputed company Resources Plan• Opportunity to earn an annual discretionary bonus if eligibility reputed company are met• Family-friendly culture, community involvement, and reputed company development opportunities Apply tot his job Apply tot his job Apply tot his job Apply To this Job