RN, Registered Nurse -Case Manager High Risk Maternity

About the position The Personal Care Guide Nurse – High Risk Maternity is responsible for providing case management services for members of Quantum Health employer groups identified with high-risk pregnancies, and families of NICU babies up to one year of life. Upon identification, the High Risk Maternity PCG will outreach to the members to provide support regarding: Benefits and coverage, network steerage, monitoring & management of health symptoms, assistance in understanding and compliance with treatment plan, depression screening, post-delivery care, and any other identified needs through management of each member. They also function as a clinical resource for other staff in the company such as Utilization Management & Patient Services. Responsibilities • Identify members for specific case management activities by utilizing established screening criteria. • Coordinate all services in an effort to provide integrated health services for each member and/or their family. • Apply the nursing process when actively managing members. • Utilize well-developed critical thinking and interpersonal skills to problem solve and make knowledgeable recommendations for needed actions. • Document all activities specific to members, caregivers, providers, facilities and clients in appropriate database. • Maintain a collaborative relationship among health care teams by communicating information, responding to requests, building rapport, participating in team problem-solving methods. • Serve as member and provider advocate by educating and guiding through the complicated healthcare system. • Provide benefit and health information to each member so they are able to make informed health decisions. • Promote the mission and core values of Quantum Health. • Assure quality of care by adhering to therapeutic standards; measuring health outcomes against member care goals and standards; following hospital and nursing division's philosophies and standards of care set by state board of nursing, state nurse practice act, and other governing agency regulations. • Maintain a working knowledge of all policies and procedures related to Clinical Operations. • Maintain a working knowledge of employer health benefit plans and know where to access benefit information. • Be a clinical resource for all Quantum Health work teams. • Assist members and clients with wellness activities, enhanced benefits, behavioral incentives. • All other duties as assigned. • Protect and take care of our company and member’s data every day by committing to work within our company ethics and policies. Requirements • Active license as a Registered Nurse in the state of Ohio, BSN preferred • Minimum of two years clinical experience with direct patient care • Minimum of one year experience with Mother/Infant, Labor & Delivery, and/or NICU experience preferred • Possess excellent critical thinking skills • Certification in Case Management preferred • Strong customer service skills • Possess excellent verbal and written communication skills • Possess excellent time management skills • Ability to make decisions that are timely and achieve results consistent with the business goals and organizational culture • Ability to work independently with minimal supervision • Strong administrative/technical skills; Comfort working on a PC using Microsoft Office (Outlook, Word, Excel, PowerPoint), IM/video conferencing (Teams & Zoom), and telephones efficiently. • Trustworthy and accountable behavior, capable of viewing and maintaining confidential information daily. • Applicants must be legally authorized to work in the United States on a permanent and ongoing future basis without requiring sponsorship. Benefits • Compensation: Competitive base and incentive compensation • Coverage: Health, vision and dental featuring our best-in-class healthcare navigation services, along with life insurance, legal and identity protection, adoption assistance, EAP, Teladoc services and more. • Retirement: 401(k) plan with up to 4% employer match and full vesting on day one. • Balance: Paid Time Off (PTO), 7 paid holidays, parental leave, volunteer days, paid sabbaticals, and more. • Development: Tuition reimbursement up to $5,250 annually, certification/continuing education reimbursement, discounted higher education partnerships, paid trainings and leadership development. • Culture: Recognition as a Best Place to Work for 15+ years, dedication to diversity, philanthropy and sustainability, and people-first values that drive every decision. • Environment: A modern workplace with a casual dress code, open floor plans, full-service dining, free snacks and drinks, complimentary 24/7 fitness center with group classes, outdoor walking paths, game room, notary and dry-cleaning services and more! Apply tot his job Apply To this Job