This job was posted by https://idahoworks.gov : For more information, please see: https://idahoworks.gov/jobs/2288050 Maternity Care Management Nurse

Work from home within Oregon, Washington, Idaho or Utah

Who We Are Looking For:

Every day, Cambia\'s dedicated team of Care Management RN\'s are living our mission to make health care easier and lives better. As a member of the Clinical Services team, our Care Management RN\'s provide clinical care management (such as case management, disease management, and/or care coordination) to best meet the member\'s specific healthcare needs and to promote quality and cost-effective outcomes. Oversees a collaborative process with the member and those involved in the member\'s care to assess, plan, implement, coordinate, monitor and evaluate care as needed - all in service of creating a person-focused health care experience.

Are you a Maternity RN looking to transition out of bedside care and into a role that still utilizes your clinical expertise, but offers a fresh challenge? Is your goal to promote quality, cost-effective outcomes and improve overall health and wellbeing? Then this role may be the perfect fit.

What You Bring to Cambia:

Qualifications:

• Associates or Bachelor\'s Degree in Nursing or related field
• 3 years of case management, utilization management, disease management, or behavioral health case management experience
• Equivalent combination of education and experience
• Must have licensure or certification, in a state or territory of the United States, in a health or human services discipline that allows the professional to conduct an assessment independently as permitted within the scope of practice for the discipline (e.g. medical vs. behavioral health) and at least 3 years (or full time equivalent) of direct clinical care.
• Must have at least one of the following: Certification as a case manager from the URAC-approved list of certifications; or Bachelor\'s degree (or higher) in a health or human services-related field (psychiatric RN or Master\'s degree in Behavioral Health preferred for behavioral health care management); or Registered nurse (RN) license (must have a current unrestricted RN license for medical care management)

Skills and Attributes:

• Healthcare Industry Acumen: Possesses knowledge of current trends, technological advancements, and contractual agreements within the health insurance industry, enabling informed decision-making and effective navigation of complex healthcare systems.

• Technical Competence: Demonstrates proficiency in general computer skills, including Microsoft Office, Outlook, and internet search capabilities, with familiarity with healthcare documentation systems, such as electronic health records (EHRs) and practice management systems (PMS).

• Effective Communication and Interpersonal Skills: Exhibits strong oral, written, and interpersonal communication skills, with the ability to provide exceptional customer service, empathize with patients and families, and collaborate with interdisciplinary teams to achieve optimal patient outcomes.

• Policy Interpretation and Decision-Making: Possesses the ability to accurately interpret and apply organizational policies and procedures, make informed decisions, and communicate complex information effectively to patients, families, and healthcare teams.

• Autonomous Workload Management: Demonstrates strong organization and time management skills, with the ability to prioritize tasks, manage workload independently, and maintain productivity in a fast-paced healthcare environment.

• Critical Thinking and Decision-Making: Applies critical thinking skills to make informed decisions within individual role and resp nsibility, weighing the impact of decisions on patient care, organizational operations, and healthcare outcomes.

What You Will Do at Cambia:

Comprehensive Case Management: Responsible for assessment, planning, implementation, coordination, monitoring, and evaluation of case management activities to ensure individualized care for members.

Clinical Expertise: Applies clinical judgment and expertise to ensure compliance with medical policy, medical necessity guidelines, and accepted standards of care, utilizing evidence-based criteria and practicing within the scope of licensure.

Collaboration and Consultation: Collaborates with physician advisors, internal departments, and external customers to resolve claims, quality of care, member or provider issues, and identifies problems or needed changes, recommending resolutions.

Communication and Documentation: Responds to members, providers, and regulatory organizations in a professional manner, protecting confidentiality, and provides consistent and accurate documentation.

Quality Improvement: Participates in quality improvement efforts, recommending changes and implementing solutions to improve member outcomes and care.

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