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ProgenyHealth Nurse Case Manager - Maternity Program - Remote in Plymouth Meeting, Pennsylvania

ProgenyHealth is a leading provider of care management solutions for maternal and infant populations. We partner with health plans and their obstetric, perinatal, and neonatal providers to work collaboratively in developing a plan of care specific to the needs of each member/family – from prenatal care to delivery to admission to the intensive care nursery until they are safely transitioned from the hospital, up to the first year of an infant’s life. Our program promotes appropriate utilization, improves access, educates members and their families, addresses social determinants of health, reduces costs, and improves outcomes.

The Case Manager is a Registered Nurse in a telephonic managed care setting combining strong clinical knowledge and critical thinking to facilitate a care plan that will ensure quality medical care for the member population serviced by ProgenyHealth. The Case Manager for Maternity program will focus on empowering the member to support optimal wellness while advocating for necessary medical services.

Responsibilities Include:

  • Assesses the physical, functional, psychological, environmental, educational, and financial needs of members referred to the Case Management program.

  • Completes needs assessments for all members in CM and develops care plans individualized to the needs of each member as per ProgenyHealth policies and procedures.

  • Assigns risk stratification based on complexity of medical and social needs and determines ongoing frequency of calls to continually assess plan of care.

  • Monitors the care plan to ensure effective, appropriate provision of services and adequacy of benefits.

  • Interfaces with providers to assist with care coordination activities, which can include appointments, transportation, DME, etc.

  • Provides education to members regarding condition, treatment plan, benefits, services, and how to access needed care.

  • Monitors ongoing progress towards goal achievement and reassess changes in health status throughout continuum of care.

  • Provides referrals to appropriate community resources; facilitates access and communication when multiple services are involved; monitors activities to ensure that services are actually being delivered and meeting the needs of the member.

  • Participates in interdisciplinary and client rounds with pertinent health care team members to identify, clarify, and/or prevent risk, quality, or plan of care variances.

    Qualifications:

  • Registered Nurse (RN) with a current, unrestricted license is required.

  • College degree is preferred.

  • Three or more years of experience in a Case Management role is required.

  • Previous experience in a maternity management program preferred.

  • Three or more years of clinical experience in OB/L&D or related area is required.

  • CCM certification required within the timeframe specified by company policy.

  • Experience with data entry into a database or EHR required. Must be computer literate.

  • Excellent communication skills and organizational ability are required. Must be self-motivated and willing to learn multiple tasks. Must be well organized and able to prioritize tasks.

  • Must demonstrate accuracy in spelling and documentation.

  • Demonstrated strength in working independently as well as collaboratively within a team.

  • Must have excellent interpersonal skills, telephone etiquette, and maintain positive communication at all times.

  • Must have commitment to excellence in customer service.

    Benefits/Culture:

    Some of the benefits we offer our team are:

  • Paid Time Off

  • Medical, dental, vision benefits

  • 401K with company match

  • Short- and Long-Term Disability

  • Group Life Insurance

  • Tuition reimbursement

  • Professional development opportunities

  • Business Casual work environment

  • Team oriented events throughout the year

  • Role specific - partial or full remote work week

    ProgenyHealth positively recruits people from diverse backgrounds, including individuals with disabilities - if you need an accommodation to interview, please contact us by email: careers@progenyhealth.com

    Job location:

  • This position may be performed remotely – candidates outside of the Eastern PA area will be considered.

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