Nurse Case Manager - Maternity

ProgenyHealth is a leading provider of care management solutions for premature and medically complex newborns positively impacting maternal and infant health outcomes across America. Our program builds a network of support for an uninterrupted continuum of care from prenatal health, through any resultant NICU stay, and all the way to one full year of life. Our team of neonatologists, pediatricians, and NICU nurses provide continuity of care in collaboration with providers from hospital to caregivers at home and throughout the first year of life. We help overcome systemic barriers to support healthier pregnancies and healthier starts to life for all moms and babies, one family at a time.

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.

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.