OB Case Manager RN

Job Title:

OB Case Manager (RN)

Job Description

The OB Case Manager (RN) coordinates comprehensive care for maternal and child health populations, ensuring safe, evidence-based interventions across the continuum of care. This role focuses on intake assessments, individualized care planning, discharge coordination, and continuous monitoring of clinical outcomes for obstetric and neonatal patients. The position supports Medicaid contract compliance and promotes improved maternal and neonatal outcomes while managing a high-volume caseload and maintaining high quality standards.

Responsibilities

+ Conduct thorough intake assessments for pregnant and postpartum individuals and their infants to identify clinical, psychosocial, and social determinant needs.

+ Develop individualized, evidence-based care plans for maternal and child health populations, including high-risk antepartum and NICU cases.

+ Coordinate care across the continuum, including inpatient, outpatient, and community settings, to ensure seamless transitions and continuity of care.

+ Lead and manage discharge planning activities, ensuring appropriate follow-up appointments, home care services, and community resource referrals.

+ Perform ongoing monitoring and evaluation of clinical outcomes, adjusting care plans as needed to improve maternal and neonatal health results.

+ Provide patient and family education on disease management, pregnancy and postpartum care, newborn care, and available support services.

+ Conduct outbound calls to patients and families to support care coordination, follow up on care plans, and reinforce education and engagement.

+ Respond to inbound patient calls, addressing questions, concerns, and barriers to care in a timely and compassionate manner.

+ Utilize case management and utilization management principles to ensure appropriate use of services and adherence to clinical guidelines.

+ Support Medicaid members by navigating benefits, addressing access issues, and coordinating services in alignment with program requirements.

+ Document all assessments, interventions, communications, and outcomes accurately and thoroughly in electronic health record (EHR) systems.

+ Maintain strong organizational practices to manage a high-volume caseload while meeting productivity metrics and quality benchmarks.

+ Collaborate with multidisciplinary teams, including physicians, nurses, social workers, and community partners, to optimize patient outcomes.

+ Apply knowledge of Medicaid and Medicare regulations to ensure compliance in case management activities and documentation.

+ Participate in orientation, training sessions, and ongoing professional development related to care coordination, EPIC, and other EHR platforms.

+ Engage patients using motivational interviewing and culturally competent communication to enhance adherence, self-management, and satisfaction.

+ Leverage familiarity with community resources such as Healthy Start, WIC, and SNAP to connect patients with supportive services.

+ Contribute to quality initiatives related to maternal health metrics, including HEDIS measures, by ensuring accurate data capture and follow-through.

+ Adapt to hybrid work expectations, including onsite presence as required and effective remote case management practices.

Essential Skills

+ Active, unrestricted Registered Nurse (RN) license in the state of Florida.

+ 3-5 years of clinical experience in obstetrics, high-risk antepartum, or neonatal intensive care (NICU).

+ 3-5 years of experience in case management within a managed care organization, health plan, or insurance carrier.

+ Demonstrated experience with utilization management processes and criteria.

+ Experience supporting Medicaid members in a clinical or managed care setting.

+ Strong organizational skills with the ability to manage a high-volume caseload and meet productivity metrics.

+ Excellent documentation skills with attention to detail and accuracy.

+ Proficiency in care coordination and discharge planning across multiple care settings.

+ Ability to work independently with minimal supervision while maintaining quality standards.

+ Competence in using electronic health record (EHR) systems for documentation and care coordination.

+ Ability to conduct patient care, patient education, and disease management via outbound and inbound patient calls.

Additional

Skills & Qualifications

+ Bachelor's Degree in Nursing (BSN) preferred;
Master's Degree in Nursing or related field is an added advantage.

+ Certified Case Manager (CCM) or similar case management certification is highly desirable.

+ Experience and familiarity with Medicaid and Medicare regulations as they relate to case management and utilization management.

+

Experience with motivational interviewing techniques to support behavior change and patient engagement.

+ Knowledge of maternal health quality measures, including HEDIS metrics.

+ Previous experience in managed care or health plan environments beyond the minimum requirements.

+ Proficiency with Microsoft Office…