Location: This position is located at our Dublin, OH campus with hybrid flexibility.
Who we are
Founded in 1999 and headquartered in Central Ohio, we’re a privately-owned, independent healthcare navigation organization. We believe that no one should have to navigate the cost and complexity of healthcare alone, and we’re on a mission to make healthcare simpler and more effective for our millions of members. Our big-hearted, tech-savvy team fights to ensure that our members get the care they need, when they need it, at the most affordable cost – that’s why we call ourselves Healthcare Warriors®.
We’re committed to building diverse and inclusive teams – more than 2,000 of us and counting – so if you’re excited about this position, we encourage you to apply – even if your experience doesn’t match every requirement.
About the role
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.
What you’ll do
- Identify members for specific case management activities by utilizing established screening criteria.
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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.
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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.
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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.
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Assist members and clients with wellness activities, enhanced benefits, behavioral incentives.
- All other duties as assigned.
What you’ll bring
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Active license as a Registered Nurse in the state of Ohio, BSN preferred
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Minimum of two years clinical experience with direct patient care required
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Minimum of one year experience with Mother/Infant, Labor & Delivery, and/or NICU experience preferred
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Possess excellent critical thinking skills
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Certification in Case Management preferred
- Strong customer service skills
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Possess excellent verbal and written communication skills
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Possess excellent time management skills
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Ability to make decisions that are timely and achieve results consistent with the business goals and organizational culture
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Ability to work independently with minimal supervision
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Protect and take care of our company and member’s data every day by committing to work within our company ethics and policies.
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Strong administrative/technical skills; Comfort working on a PC using Microsoft Office (Outlook, Word, Excel, PowerPoint), IM/video conferencing (Teams & Zoom), and telephones efficiently.
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Trustworthy and accountable behavior, capable of viewing and maintaining confidential information daily.
#LI-HW1 #LI-Hybrid
