OB Case Manager

Position Summary:

1. The Obstetric Case Manager (OB-CM) will serve as the primary liaison between the Pregnant High Risk members, physicians, health care providers, and community resources to coordinate the care and management of member's medical, psychological, emotional and social needs.
2. Provide comprehensive health and wellness coaching via telephone written and digital media to enhance clinical outcomes and reduce member/baby hospitalizations.
3. The OB-CM will be responsible for working with the member's physician, and the matrix partners in AvMed as well as the Member and/or family to promote quality care that is delivered in the appropriate setting.
4. The OB-CM will work with all healthcare resources to assess, plan, implement, coordinate, monitor, and evaluate services and outcomes to maximize the heath of the Member and unborn child/children.

ESSENTIAL JOB FUNCTIONS:

1. Assess Members' goals as well as they're biophysical, psychosocial, environmental, and discharge planning needs.
2. Assess, develop, implement, and monitor a comprehensive plan of care with the Obstetrician, providers, and Members/families, and other care management programs, as appropriate.
3. Obtain covered services and serve as an advocate on behalf of the Member and families for limited resources based on the member's Certificate of Coverage.
4. Act as liaison to post-hospital care providers and community resources (i.e., transportation, Home Care, La Leche League).
5. Maintain records accurately documenting the plan of care and contacts with the PCP, providers and Members, and entering all cases into AMISYS, document MOR and enter into other designated systems.
6. Communicate regularly with Care Management staff and family to assist with discharge planning and offer non-acute care options for inpatient Members.
7. Plan team conferences and family meetings, as necessary, to discuss care options with the physician and providers.

Education/Experience:

1. Registered Nurse with current Florida license.
2. Five (3-5) years acute care experience in OB/Labor and delivery or perinatal care.
3. Managed care, home health, walk-in clinics, occupational health nursing, and/or discharge planning experience.
4. Two years of case management experience.
5. Complex Case Management certification preferred, however certification must be obtained no later than one (1) year of employment with AvMed.
6. If AvMed approves time from work or provides funding assistance for the purposes of case manager certification, Case Manager must agreed to continue employment with AvMed for 1 year from the date upon which CCM certification is completed.


AvMed Health Plans is a Drug-Free Workplace, EOE.