RN Maternity Case Mgr

GuideWell; Irving (TX); On-site; USD 80,000 - 105,000; Full time

Job summary

GuideWell, via its WebTPA unit, is seeking an RN Maternity Case Manager to join the Case Management team. You will focus on wellness, education for expectant mothers, and traditional case management for high-risk pregnancies, coordinating care across providers and plans.

Responsibilities include assessing health status, coordinating discharges, contacting patients and providers, developing care plans, and monitoring outcomes to ensure quality, cost-effective care across the maternity program.

Qualifications

• 5+ years professional work experience in clinical nursing and patient assessment.
• Bachelor’s degree or related equivalent work experience.
• Graduate of an accredited school of nursing.
• RN - Registered Nurse - State Licensure in good standing.
• RN Compact State Licensure.

Responsibilities

• Maternity Case Management process includes assessing the member’s health status and care coordination needs.
• Contact with patient, family, physicians, additional health care providers, and community resources.
• Identification of alternative treatment plans, approved by all parties within cost guidelines.
• Monitor health status and adjust the care plan based on member needs.
• Identify services, resources, providers, and facilities for timely, cost-effective care.
• Develop and implement Case Management goals with documented care plans.
• Evaluate cost-effectiveness of treatment plans using available tools.
• Accurate and timely reporting as deemed appropriate by each client.
• Interpreting health plans and coordinating care per plan provisions.

Skills

Clinical nursing

Patient assessment

RN licensure

Education

Bachelor’s degree in nursing (or related)

Graduate of an accredited school of nursing

Job description

Get To Know Us!

WebTPA, a GuideWell Company, is a healthcare third-party administrator with over 30+ years of experience building unique benefit solutions and managing customized health plans.

What is your impact?

The RN Maternity Case Manager will be a member of our Case Management department and will work within the Maternity Management program, which assists in managing healthcare costs for expectant mothers. The RN Maternity Manager (MM) focuses on wellness/wellbeing and education of expectant mothers, as well as traditional case management practices as it relates to mothers-to-be with high-risk pregnancies.

What Will You Be Doing:

• Maternity Case Management process includes assessing the member’s health status and care coordination needs. Can include inpatient discharge planning, as well as possible outpatient management.
• Contact with patient, family, physicians, additional health care providers, and community resources. Contact with provider business offices and with the employer/client may also be required.
• Identification of alternative treatment plans, which would have to be approved by all parties. These alternative care plans will be based on quality care within cost containment guidelines, allowing available claims dollars to be used in the most judicious manner possible.
• Monitor the health status and the impact of the treatment plan for each member. The Maternity Manager will be responsible for altering the care plan as deemed appropriate by the dynamic, ever-changing member needs.
• Identification of services, resources, providers, and facilities that could best serve members in a timely and cost-effective manner, to promote optimum value for the member and reimbursement source.
• Development and implementation of Case Management goals, both short and long term, with documented care plans.
• Utilize technology/resources to evaluate the cost-effectiveness of the elected treatment plan, pre-implementation and post-implementation. This outcome measurement will be used in determining the effective results and in establishing future patient-centered care plans.
• Accurate and timely reporting as deemed appropriate by each client.
• Interpreting individual health plans and authorizing/coordinating care in accordance with plan provisions.

What You Must Have:

• 5+ years professional work experience in clinical nursing and patient assessment.
• Related Bachelor’s degree or additional related equivalent work experience
• Graduate of an accredited school of nursing
• RN - Registered Nurse - State Licensure in good standing.
• RN Compact State Licensure

What We Prefer:

• (CCM) Certified Case Manager preferred
• Prior experience with maternal health, prenatal care, and/or high-risk pregnancy management in a clinical setting.
• Prior experience in utilization management or case management preferred, preferably within the managed care environment
• Knowledgeable in medical terminology, reasonable and necessary treatment plans, delivery quality health care services and cost containment practices.
• Ability to collaborate with cross-operational areas within the organization.
• Intensive care or higher-acuity patient experience preferred.
• Knowledge of managed care in a self-funded employer population is preferred.
• Ability to identify problems such as underutilization or overutilization of services
• Ability to promote and maintain quality care through analysis

General Physical Demands

Sedentary work: Exerting up to 10 pounds of force occasionally to move objects. Jobs are sedentary if traversing activities are required only occasionally.

Physical/Environmental Activities

Must be able to travel to multiple locations for work (i.e. travel to attend meetings, events, conferences). Occasionally

We are an Equal Employment Opportunity employer committed to cultivating a work experience where everyone feels like they belong and can perform at their best in pursuit of our mission. All qualified applicants will receive consideration for employment.