Care Manager; RN

Description Summary/Position Objectives

This position is responsible for the planning, development, implementation, and timely oversight of care plans for members with identified Care Management (CM) needs. The incumbent is responsible for managing the care management process as defined by improving coordination, continuity, accessibility, and appropriate utilization of health care services and community resources for high-risk and special needs members.

Maryland Care Management, Inc. (MCMI) manages Maryland Physician Care's (MPC) statewide provider network of hospitals and physicians. Maryland Physicians Care has been providing services to the Health Choice Medicaid populations since 1996, and we are proud of our footprint in the community. With over 230,000 members, MPC consistently has been one of MD's largest Medicaid-managed care organizations.

MCMI recognizes the importance of flexibility and offers multiple work arrangements. Along with competitive pay, we offer excellent benefits (medical, dental, and vision plans, 100% employer Term Life Insurance, Short and Long-Term Disability, 401k Employer Match up to 4%) as well as 20 days of PTO, and tuition assistance/professional development plans.

Your future colleagues at MCMI are welcoming, friendly, and eager to help each other succeed. We are committed to Diversity, Equity, and Inclusion, providing organizational‑wide social opportunities, and constantly improving our ongoing efforts to positively impact our members' lives.

• Assist in developing, maintaining, and monitoring processes to promote the timely identification and assessment of high risk and special needs members.
• Serve as an interdisciplinary team member in management of identified members, performing clinical/social determinants of health assessments and in collaboration with physicians, determining medical needs.
• Conduct telephone or face‑to‑face interviews of members to identify risk factors and the need for care management.
• Foster professional networks and relationships with service and resource providers to promote continuity and quality of care for members.
• Initiate, develop, plan, and implement care plans designed to promote the delivery of quality care and service to members with identified CM needs.
• Utilize clinical judgment to discharge members from care management according to plan policies and procedures.
• Maintain care management records according to plan policies and procedures and ensure data integrity in health plan information systems.
• Collect, evaluate, and report clinical, functional and program activity as applicable.
• Educate members' medical providers regarding the members' special needs to ensure consideration of the unique needs of the patients in treatment planning.
• Coordinate and communicate with community support and social service systems for members.
• Reduce care costs without sacrificing quality through effective service coordination and multidisciplinary collaboration.

• Assist with special projects to meet plan and departmental goals.
• Follow HIPAA guidelines, maintain confidentiality of patient information and adhere to appropriate release of medical information procedures.
• Identify and report gaps in the service delivery system.

• Use Microsoft Office suite and common computer and office hardware proficiently.
• Conduct presentations and training before small and large groups.
• Know the American Disabilities Act of 1990.

• Registered Nurse with current state license. Must have experience helping members using community agencies.
• Two years of managed care experience preferred.
• Experience with pediatrics, NICU, postpartum, or maternal health required.
• Registered Nurse with BSN preferred.

Following applicable federal, state, and local laws, MCMI prohibits discrimination in employment based on race, color, religion, sex (including pregnancy, gender identity, and sexual orientation), national origin, age, disability, genetic information, or any other characteristic protected by law. This commitment extends to all aspects…