Description
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.
Job Role
The Case Manager will focus on empowering the members’ family to support optimal wellness while advocating for the necessary medical services across the health care continuum. The Case Manager works 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 Inc. based on the CMSA national standards for case management practice.
Responsibilities
Must reside and be licensed in South Carolina.
Assess the physical, functional, psychological, environmental, educational, and financial needs of members referred to the Case Management program.
Complete needs assessments for all members in CM and develop care plans individualized to the needs of each member as per ProgenyHealth policies and procedures.
Assign risk stratification based on complexity of medical and social needs and determine ongoing frequency of calls to continually assess plan of care.
Monitor the care plan to ensure effective, appropriate provision of services and adequacy of benefits.
Interface with providers to assist with care coordination activities, which can include appointments, transportation, DME, etc.
Provide education to members regarding condition, treatment plan, benefits, services, and how to access needed care.
Monitor ongoing progress toward goal achievement and reassess changes in health status throughout the continuum of care.
Provide referrals to appropriate community resources; facilitate access and communication when multiple services are involved; monitor activities to ensure that services are actually being delivered and meeting the needs of the member.
Participate in interdisciplinary and client rounds with pertinent healthcare team members to identify, clarify, and/or prevent risk, quality, or plan of care variances.
Qualifications
Registered Nurse (RN) with a current, unrestricted license is required (SC license and residency required for this position).
College degree preferred.
Experience in a Case Management role preferred.
Previous experience in a maternity management program preferred.
Three (3) or more years of clinical experience in a Level III or above NICU required.
CCM certification required within the timeframe specified by company policy.
Experience with data entry into a database or EHR required; must be computer literate.
Excellent communication skills and organizational ability; 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.
Demonstrated strength in working independently as well as collaboratively within a team.
Must have excellent interpersonal skills, telephone etiquette, and maintain positive communication at all times.
Must have commitment to excellence in customer service.
Benefits
Paid Time Off
Paid Parental Leave
Medical, dental, vision benefits
401K with company match
Short- and Long-Term Disability
Group Life Insurance
Tuition reimbursement
Professional development opportunitiesBusiness Casual work environment
ProgenyHealth positively recruits people from diverse backgrounds, including individuals with disabilities - if you need an accommodation to interview, please contact us by email: careers@progenyhealth.com
Equal Opportunity Employer, including individuals with disabilities and veterans.