RN Case Manager

Actalent is Hiring an RN Case Manager // Must Have OB Experience!!

The Obstetrics Case Manager (OB RN Case Manager) 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 ongoing monitoring of clinical outcomes for pregnant and postpartum individuals and their newborns. The position requires strong documentation skills, proficiency with electronic health record (EHR) systems, and the ability to manage a high-volume caseload while maintaining quality and compliance standards.

The role supports Medicaid contract requirements and is dedicated to improving maternal and neonatal outcomes within the community.

Responsibilities

• Conduct thorough intake assessments for maternal and child health patients to identify clinical needs, risk factors, and appropriate levels of care.
• Develop individualized, evidence-based care plans that address obstetric, neonatal, and high-risk antepartum and postpartum needs.
• Coordinate care across the continuum, including inpatient, outpatient, and community-based services, to ensure seamless transitions and continuity of care.
• Manage discharge planning for obstetric and neonatal patients, ensuring safe transitions, appropriate follow-up, and clear patient instructions.
• Monitor clinical outcomes and quality measures for maternal and child health populations and adjust care plans based on patient progress and changing needs.
• Provide patient education on disease management, maternal and newborn health, and available community resources to support long-term health outcomes.
• Perform outbound and inbound patient calls to conduct follow-up, reinforce care plans, and support adherence to recommended treatments and appointments.
• Coordinate utilization management activities, ensuring appropriate use of services in alignment with managed care and Medicaid guidelines.
• Support Medicaid members by navigating benefits, addressing barriers to care, and promoting access to necessary services and resources.
• Document all assessments, interventions, communications, and outcomes accurately and thoroughly in EHR and case management systems.
• Maintain strong organizational practices to manage a high-volume caseload while meeting productivity metrics and quality standards.
• Collaborate effectively with multidisciplinary teams, including physicians, nurses, social workers, and community program staff, to optimize patient care.
• Use care coordination and discharge planning skills to reduce avoidable readmissions and improve maternal and neonatal health outcomes.
• Participate in training and ongoing professional development related to maternal health quality measures, Medicaid regulations, and case management best practices.
• Adapt to hybrid work requirements, including onsite orientations, training sessions, and occasional visits, while maintaining consistent patient support.
• Contribute to a mission-driven culture focused on improving maternal and child health outcomes across Florida through compassionate, patient-centered care.

Essential Skills

• Active, unrestricted Registered Nurse (RN) license in the state of Florida.
• 35 years of clinical nursing experience in obstetrics, including active delivery, high-risk antepartum, postpartum, or neonatal intensive care (NICU) settings.
• 35 years of experience in case management within a managed care organization, health plan, or insurance carrier.
• Demonstrated experience with utilization management in a healthcare or managed care environment.
• Experience supporting Medicaid members and navigating Medicaid-related care and services.
• Strong organizational skills with the ability to…