General Summary of PositionThis position will be responsible for the annual and periodically required Comprehensive Clinical Assessment as cited in section C.3.27.2 of the Department of Health Care Finance awarded contract. The Maternal Health Field RN Case Manager is a specialty case management role that will be responsible for the District of Columbia Region. This position requires up to 85% travel to our Maternal MedStar Family Choice D.C. Enrollees.
A women's health nursing background is strongly desired, along with strong case management experience. The Maternal Health Field RN Case Manager conducts activities and functions required for this role under the Women's Health Guidelines. The Maternal Health Field RN Case Manager will be responsible for the referral of MedStar Family Choice Enrollees to other MedStar Family Choice programs as needed, i.e., Behavioral Health, Food Insecurity relief, and Non-Medical Transportation. They are also responsible for the reporting of Enrollees requiring assistance with Medicare and/or Medicaid beneficiary support, Medicaid for Nursing Home Placement, Crime Victims Vocational Rehabilitation, and any/all other third-party coverage, including other available local, state, and federal programs.
Primary Duties and Responsibilities- Integrates physical health behavioral health social environmental into a single person-centered seamless system of care.
- Promotes person-centered approach to service and care planning that honors each Member's priorities goals needs and preferences.
- Encourages Enrollee engagement in the person-centered service planning process and the use of person-centered planning teams with expertise in community integration behavioral health and health and wellness.
- Leverages providers community partners and local community resources to ensure comprehensive coordinated and culturally appropriate care for each member.
- Provides service and support to maintain members in the least restrictive and most appropriate setting as possible.
- Leverages the use of evidence-based practice guidelines clinical pathways technology solutions and clinical decision support tools.
- Provides Case Management for designated member population to include support for self-direction nursing home transition transition of care and Utilization Management (UM) activities. Completes field-based member assessments and identifies activities and interventions based on the member needs of this continuum aligning the level of engagement and interventions with identified member needs.
- Oversees daily weekly and monthly functions of Field Case Manager coordinating member assessments and establishing priorities as needed. This includes the duties clinical analysis documentation and follow up for member clinical reviews and other similar duties to effectively manage the MedStar Family Choice D.C. case managed member population.
- Prepares and provides reports to manager(s) on work in progress and address any backlogs for resolution.
- Responsible for informing members about annual required assessments in-person centered service planning processes service alternatives service delivery options e.g. opportunities for self -direction roles rights including MedStar Family Choice D.C Fair Hearing rights risks and responsibilities. Assists with fair hearing requests when needed and requested and to protect the members' health welfare and quality on an ongoing basis.
- Collects the necessary information including at a minimum: member preferences strengths and goals to inform the development of the person-centered needs and the reevaluation of level of care annually or more frequently as needed.
- Assists member with person-centered care plans.
- Works with members to complete activities necessary to maintain MedStar Family Choice D.C. eligibility.
- Explores coverage of services to address identified member needs through other sources including services provided under medical assistance Medicare or private insurance and other community resources.
- Actively coordinates with other individuals and entities in the care delivery of member services for physical behavioral and support service needs.
- MedStar Family Choice DC policies procedures training quality oversight and monitoring for staff and contracted field case managers will ensure consistency in the execution and delivery of our MFC Model of Care.
Minimal QualificationsEducation- Bachelor's degree in Nursing required
Experience- 1-2 years At least 1 year working in social service or health care related setting required and
- 1-2 years Experience working with people with Developmental Disabilities HIV Behavioral Health and/or other related vulnerable populations required
Licenses and Certifications- RN - Registered Nurse - State Licensure and/or Compact State Licensure RN - Registered Nurse - State Licensure and/or Compact State Licensure Upon Hire required
Knowledge Skills and Abilities- Knowledge of the home and community-based service system and how to access and arrange for services
- Ability to conduct field-based member assessments up to 85% of the time
- Experience conducting Department of Health Care Finance needs assessments
- Cultural competency and the ability to provide informed advocacy
- Ability to interact with physicians and other health care professionals in a professional manner is required
- Experience with section C.3.27.2 of the Department of Health Care Finance awarded contract
This position has a hiring range of USD $89,065.00 - USD $162,801.00 /Yr.
