Maternal Case Manager - RN
The Maternal Case Manager is responsible for the development, implementation, daily management, and tracking of members identified as at-risk or high-risk during their pregnancy and post-partum period. The Maternal Case Manager directs the activities related to the delivery of the Maternal Case Management Program in accordance with established policies and procedures for Steward Health Choice.
The Maternal Case Manager provides care coordination and case management to pregnant members. Receives case management referrals from Prior Authorization or Utilization Review Behavioral Health staff, facility referrals, high risk indicators from Steward Health Choice member surveys, state reporting, reports such as the Active Care Roster, the MOPS report and the in-patient census, and the member's Primary Care Obstetrician (PCO). Provide outreach to high risk members, as outlined in Maternal Case Management policies. Assist pregnant and post-partum members with making appointments, securing transportation, navigating the health care system Make referrals to meet the needs of the pregnant member and/or newborn. Educate and encourage members to engage in healthy behaviors during pregnancy, including attendance at all prenatal and post-partum checks. Coordinate member care with PCO. Review and authorize as appropriate Pharmacy PA requests for pregnant members. Collaborate with the Health Choice Medical Director. Provide reports as requested by the Maternal Child Health Manager. Assist with program development and updates to department policies and procedures. Other duties as assigned.
Active, current, valid, and unrestricted Utah (UT) state Registered Nurse (RN) or Licensed Practical Nurse (LPN) preferred
If licensed, in good standing
Minimum of two (2) years of obstetrics experience preferred
Minimum of two (2) years of managed care experience preferred
Case management experience preferred
Specialized knowledge in maternal / child nursing; excellent verbal and written communication skills; Medicaid / Medicare guidelines