Job Description
About the position
The Personal Care Guide Nurse – High Risk Maternity is responsible for providing case management services for members of Quantum Health employer groups identified with high-risk pregnancies, and families of NICU babies up to one year of life. Upon identification, the High Risk Maternity PCG will outreach to the members to provide support regarding: Benefits and coverage, network steerage, monitoring & management of health symptoms, assistance in understanding and compliance with treatment plan, depression screening, post-delivery care, and any other identified needs through management of each member. They also function as a clinical resource for other staff in the company such as Utilization Management & Patient Services.
- Responsibilities
- Identify members for specific case management activities by utilizing established screening criteria.
- Coordinate all services in an effort to provide integrated health services for each member and/or their family.
- Apply the nursing process when actively managing members.
- Utilize well-developed critical thinking and interpersonal skills to problem solve and make knowledgeable recommendations for needed actions.
- Document all activities specific to members, caregivers, providers, facilities and clients in appropriate database.
- Maintain a collaborative relationship among health care teams by communicating information, responding to requests, building rapport, participating in team problem-solving methods.
- Serve as member and provider advocate by educating and guiding through the complicated healthcare system.
- Provide benefit and health information to each member so they are able to make informed health decisions.
- Promote the mission and core values of Quantum Health.
- Assure quality of care by adhering to therapeutic standards; measuring health outcomes against member care goals and standards; following hospital and nursing division's philosophies and standards of care set by state board of nursing, state nurse practice act, and other governing agency regulations.
- Maintain a working knowledge of all policies and procedures related to Clinical Operations.
- Maintain a working knowledge of employer health benefit plans and know where to access benefit information.
- Be a clinical resource for all Quantum Health work teams.
- Assist members and clients with wellness activities, enhanced benefits, behavioral incentives.
- All other duties as assigned.
- Protect and take care of our company and member’s data every day by committing to work within our company ethics and policies.
- Requirements
- Active license as a Registered Nurse in the state of Ohio, BSN preferred
- Minimum of two years clinical experience with direct patient care
- Minimum of one year experience with Mother/Infant, Labor & Delivery, and/or NICU experience preferred
- Possess excellent critical thinking skills
- Certification in Case Management preferred
- Strong customer service skills
- Possess excellent verbal and written communication skills
- Possess excellent time management skills
- Ability to make decisions that are timely and achieve results consistent with the business goals and organizational culture
- Ability to work independently with minimal supervision
- Strong administrative/technical skills; Comfort working on a PC using Microsoft Office (Outlook, Word, Excel, PowerPoint), IM/video conferencing (Teams & Zoom), and telephones efficiently.
- Trustworthy and accountable behavior, capable of viewing and maintaining confidential information daily.
- Applicants must be legally authorized to work in the United States on a permanent and ongoing future basis without requiring sponsorship.
- Benefits
- Compensation: Competitive base and incentive compensation
- Coverage: Health, vision and dental featuring our best-in-class healthcare navigation services, along with life insurance, legal and identity protection, adoption assistance, EAP, Teladoc services and more.
- Retirement: 401(k) plan with up to 4% employer match and full vesting on day one.
- Balance: Paid Time Off (PTO), 7 paid holidays, parental leave, volunteer days, paid sabbaticals, and more.
- Development: Tuition reimbursement up to $5,250 annually, certification/continuing education reimbursement, discounted higher education partnerships, paid trainings and leadership development.
- Culture: Recognition as a Best Place to Work for 15+ years, dedication to diversity, philanthropy and sustainability, and people-first values that drive every decision.
- Environment: A modern workplace with a casual dress code, open floor plans, full-service dining, free snacks and drinks, complimentary 24/7 fitness center with group classes, outdoor walking paths, game room, notary and dry-cleaning services and more!
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