Integrated Nurse Case Manager, Registered Nurse – Maternal Health, Perinatal

This is a fully remote position, open to applicants in Virginia.

📋 Description

• Accountable for delivering case management services within the limits of licensure; formulates, oversees, assesses, and modifies the member's care plan to address their needs, with the aim of enhancing member health care throughout the care continuum.

• Conducts clinical assessments either via phone or in-person to identify, evaluate, coordinate, and manage the needs of members, which include physical and behavioral health, social services, and long-term services.

• Recognizes members at high risk for complications and collaborates on care coordination alongside the member and healthcare team.

• Oversees chronic illnesses, co-morbidities, and/or disabilities, ensuring the cost-effective and efficient use of health benefits; engages in gap in care management for quality initiatives.

• Aids in the execution of member care plans by facilitating authorizations/referrals within the benefits framework or extra-contractual agreements, as allowed.

• Collaborates with Medical Directors, Physician Advisors, and/or Inter-Disciplinary Teams regarding care management treatment strategies.

• Presents cases during case conferences to foster a multidisciplinary approach. Ensures adherence to regulatory, accrediting, and company policies and procedures.

• May assist in resolving issues related to providers, claims, or services.

⛳️ Requirements

• A minimum of 3 years of Nursing experience is REQUIRED.

• Preferred experience in Case Management.

• Preference for candidates with Managed Care or Health Plan experience.

• Experience with both low and high-risk pregnant populations (Maternal Health / Perinatal / OB-GYN / Labor and Delivery / Mother-Baby / Postpartum) is preferred.

• Strong understanding of the physical, psychological, socio-cultural, and cognitive needs of patients.

• Exceptional communication skills, both verbal and written, along with strong problem-solving and analytical abilities.

🏝️ Benefits

• Medical, Dental, and Vision plans.

• Adoption, Fertility, and Surrogacy Reimbursement up to $10,000.

• Paid Time Off and Sick Leave.

• Paid 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 Guild Education.

• Student Debt Pay Down – $10,000.

• Reimbursement for certifications and free access to complete CEUs and professional development.

• Pet Insurance.

• Legal Resources Plan.

• Employees have the opportunity to earn an annual discretionary bonus if established system and employee eligibility criteria are met.