Case Management Nurse

Plymouth Meeting, PA posted on October 1

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ProgenyHealth is a leading provider of care management solutions for premature and medically complex newborns. We partner with health plans and their neonatal providers to work collaboratively in developing a plan of care specific to the needs of each child - from admission to the intensive care nursery until they are safely transitioned from the hospital, through the first year of life. Our program promotes appropriate utilization, improves access, educates family members, reduces costs, and improves outcomes.

Job Role

The Case Manager is a registered nurse managing the continuum of care for infants and their families. The Case Manager works 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 high-risk member population serviced by ProgenyHealth based on national standards for case management practice. The Case Manager will focus on empowering the family to support optimal wellness while advocating for necessary medical services.

  • Completing needs assessments for all infants in case management and developing care plans individualized to the needs of each infant and their family
  • Provides ongoing case management services to assist families after discharge as the primary contact to assist with care coordination needs throughout the first year of life
  • Utilizes the case management process of engaging, assessing, planning, implementing, monitoring, and, evaluating the needs of the high-risk neonatal population
  • Acting as a member advocate by the appropriate selection of services, based upon member’s benefits, for appropriate utilization of resources, and providing an ongoing evaluation of member outcomes
  • Working in a telephonic managed care setting, combining strong clinical knowledge and critical thinking to facilitate a plan of care that will ensure quality medical care for the high-risk member population serviced by ProgenyHealth.
  • Participating in case management rounds with ProgenyHealth and client teams to discuss barriers and opportunities to improve health outcomes
  • Collaborating with other ProgenyHealth staff, families, facility staff, community agencies, primary care and specialist offices to ensure that evidence-based protocols are utilized in treatment plan

Qualifications

  • Registered Nurse (RN) with a current, unrestricted license is required.
  • Three or more years of clinical experience in a pediatric environment is required.
  • CCM preferred; required to obtain when meeting the requirements for certification.
  • Two or more years of managed care experience in a hospital, integrated health system or health plan in a case management and/or discharge planning role is preferred
  • For 100% telecommuting positions: Five (5) or more years of managed care experience in a health plan in a case management role is required.
  • Experience with data entry into a database or EHR required. Must be computer literate.
  • Excellent communication skills and organizational ability is 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
  • Ability to perform job functions with autonomy and be a self-starter
  • Demonstrated strength in working independently as well as collaboratively within a team environment
  • Must possess excellent interpersonal skills, telephone etiquette and maintain positive communication at all times

Benefits/Culture

Our team is our most important asset. some of the benefits we offer our team are:

  • 401K with company match
  • Medical and dental benefits
  • Long Term Disability
  • Paid Time Off
  • Business Casual Work environment
  • Team orientated events throughout the year
  • Role specific - partial or full telecommuting (after training period)

Wage

DOE

Experience

Any

Type

Full-time