RN Care Manager - Maternity

We recognize that work is a part of life, not separate from it, and foster a flexible environment where your health and wellbeing are prioritized. At Capital you will work alongside a caring team of supportive colleagues, and be encouraged to volunteer in your community. We value your professional and personal growth by investing heavily in training and continuing education, so you have the tools to do your best as you develop your career. And by doing your best, you’ll help us live our mission of improving the health and well-being of our members and the communities in which they live. Capital Blue Cross is an independent licensee of the Blue Cross Blue Shield Association. We are an equal opportunity employer and do not discriminate on the basis of race, color, religion, national origin, gender, sexual orientation, gender identity, age, genetic information, physical or mental disability, veteran status, or marital status, or any other status protected by applicable law.

At Capital Blue Cross, we promise to go the extra mile for our team and our community. This promise is at the heart of our culture, and it’s why our employees consistently vote us one of the “Best Places to Work in PA.” The RN Care Manager is responsible for the coordination of services for members who meet established criteria, with an emphasis on education/self-management and promoting quality care and cost-effective outcomes. The Care Manager uses a collaborative process to assess Member needs, review options for services and resources, develop and implement a plan of care, coordinate resources, monitor progress, evaluate Member status, discharge Members, and fully document the individualized member care management process and outcome. The care manager will address, medical, psychosocial, clinical needs, and behavioral health needs including members with mental health and substance use disorder needs. Care Managers provide counseling and referrals to community/local/state programs; collaborate with caregivers, providers, community agencies, behavioral health, and other resources to coordinate care to achieve member’s optimal health status. The Care Manager is responsible for the management and oversight of a caseload of moderate - high risk Members with complex medical/behavioral /psychosocial needs.

Uses a collaborative process and serves as a liaison between the participant, family and significant others, behavioral and medical physician(s) and other members of the treatment team. Develops prioritized goals and health actions that assist participants with the implementation of appropriate self-directed care decisions and support improvement in health and self-reliance. Advocates for members and families by helping them to coordinate care and navigate resources to reduce barriers and meet healthcare needs. Analyzes and evaluates referrals for potential enrollment of Members into Care Management Program(s) using established criteria. Conducts assessments to obtain information for a participant-centered plan of care and determination of acuity level, functional status, psychosocial status, and barriers. Obtains consent forms necessary for candidates accepted into the Care Management Program. Applies established criteria for discharge and discharges the Member from the Care Management Program(s) when the criteria are met. Conducts all care management activities, including documentation, in accordance with established departmental policies and procedures. Complies with all Clinical Management and corporate policies and procedures. Builds relationships with members, their families, and implements interventions that move assigned members toward goals of improved knowledge, self-management, and long term care outcomes of stabilization. Identifies and reports quality of care issues in accordance with established departmental policies and procedures. Maintains member confidentiality at all times. Attends company and departmental meetings and training sessions as required.