RN, Registered Nurse -Case Manager High Risk Maternity (closing 1/20)

Who we are

Founded in 1999 and headquartered in Central Ohio, we’re a privately-owned, independent healthcare navigation organization. We believe that no one should have to navigate the cost and complexity of healthcare alone, and we’re on a mission to make healthcare simpler and more effective for our millions of members. Our big-hearted, tech-savvy team fights to ensure that our members get the care they need, when they need it, at the most affordable cost – that’s why we call ourselves Healthcare Warriors®.

We’re committed to building diverse and inclusive teams – more than 2,000 of us and counting – so if you’re excited about this position, we encourage you to apply – even if your experience doesn’t match every requirement.

About the role

The Personal Care Guide Nurse – High Risk Maternity is responsible for providing case management services for members of Quantum Health employer groups identified with high-risk pregnancies, and families of NICU babies up to one year of life. Upon identification, the High Risk Maternity PCG will outreach to the members to provide support regarding: Benefits and coverage, network steerage, monitoring & management of health symptoms, assistance in understanding and compliance with treatment plan, depression screening, post-delivery care, and any other identified needs through management of each member. They also function as a clinical resource for other staff in the company such as Utilization Management & Patient Services.

Location: This position is located at our Dublin, OH campus with hybrid flexibility.

What you’ll do (Essential Responsibilities)

• Identify members for specific case management activities by utilizing established screening criteria.
• Coordinate all services in an effort to provide integrated health services for each member and/or their family.
• Apply the nursing process when actively managing members.
• Utilize well-developed critical thinking and interpersonal skills to problem solve and make knowledgeable recommendations for needed actions.
• Document all activities specific to members, caregivers, providers, facilities and clients in appropriate database.
• Maintain a collaborative relationship among health care teams by communicating information, responding to requests, building rapport, participating in team problem-solving methods.
• Serve as member and provider advocate by educating and guiding through the complicated healthcare system.
• Provide benefit and health information to each member so they are able to make informed health decisions. Promote the mission and core values of Quantum Health.
• Assure quality of care by adhering to therapeutic standards; measuring health outcomes against member care goals and standards; following hospital and nursing division's philosophies and standards of care set by state board of nursing, state nurse practice act, and other governing agency regulations.
• Maintain a working knowledge of all policies and procedures related to Clinical Operations.
• Maintain a working knowledge of employer health benefit plans and know where to access benefit information.
• Be a clinical resource for all Quantum Health work teams.
• Assist members and clients with wellness activities, enhanced benefits, behavioral incentives.
• All other duties as assigned.

What you’ll bring (Qualifications)

• Licenses/Certifications: Current and active license as a Registered Nurse in the state of Ohio, BSN preferred
• Minimum of two years clinical experience with direct patient care required
• Minimum of one year experience with Mother/Infant, Labor & Delivery, and/or NICU experience preferred
• Possess excellent critical thinking skills
• Certification in Case Management preferred
• Strong customer service skills
• Possess excellent verbal and written communication skills
• Possess excellent time management skills
• Ability to make decisions that are timely and achieve results consistent with the business goals and organizational culture
• Ability to work independently with minimal supervision
• Protect and take care of our company and member’s data every day by committing to work within our company ethics and policies.
• Strong administrative/technical skills; Comfort working on a PC using Microsoft Office (Outlook, Word, Excel, PowerPoint), IM/video conferencing (Teams & Zoom), and telephones efficiently.
• Trustworthy and accountable behavior, capable of viewing and maintaining confidential information daily.