RN Maternal Health Case Manager

Job Description

Job Description

SUMMARY :

NACC’s mission is to promote the health & wellness of mind, body, and spirit of Native American families. We offer a full range of healthcare services that include Medical, Behavioral Health, Dental, and Substance Abuse.

The ideal candidate should have experience organizing, monitoring work performance and progress, and clinical experience in maternal health.

This position reports to the Medical Nursing Supervisor and assists in the assessment, planning, implementation and evaluation of patient care to a culturally diverse population.

The RN will assist in providing prenatal, perinatal, and postpartum nursing care in both outpatient ambulatory and community settings.

Candidates must possess strong communication and organizational skills as well as the ability to resolve workplace issues effectively.

DUTIES AND RESPONSIBILITIES :

• Patient Case Management :
• Responsible for the coordination of care for clinic prenatal, perinatal, and postpartum patients. Duties may include but are not limited to population management and tracking of patient engagement in care;
• scheduling patient appointments, imaging, transfers of care and hospital admissions; navigating referrals to specialists : coordination of outpatient / inpatient continuity of care;

tracking of high-risk patients and abnormal test results.

• Perform assessment of patient's unmet social needs and help patients navigate community resources including childbirth classes, doula services, WIC, dental care, nutritionists / lactation consultants, baby care supplies, Project Child / Child Protection Services and other social services as needed.
• Completes accurate, timely documentation of patient encounters in the electronic medical record. Documentation and records requirements include completion of office visit notes, updating patient OB care sheets, acquiring newborn records and closing patient OB charts according to clinic protocol.
• Conduct population management outreach phone calls to promote engagement in care for patients lost to follow-up. Population calls can include rescheduling missed OB appointments positive UPT follow-up, non engagement calls postpartum fo11ow-up, and newborn check reminders.
• Outpatient Clinical Care :
• Conducts nurse-led prenatal visits through the utilization of clinic standing orders. Nurse-led visits include prenatal planning.

OB intake visit, 08 complete physical, routine prenatal follow-up visits, newborn checkups, and the postpartum exam.

• Perform other program duties as requested to ensure the delivery of high quality, accessible prenatal care. Duties include, but are not limited to, maintenance of patient educational material and coordination of prenatal supplies in clinic.
• Community-based Care :
• Provide professional clinical care (including triage, assessment, intervention, evaluation) in varying community settings, prioritizing trauma-informed care principles and patient-led care plans.
• Deliver skilled interventions including obstetric assessment, medication administration, phlebotomy, education, standing orders, and vital signs.
• Conduct nurse-led or provider level visits through the utilization of standing orders.
• In addition to maternal health assessment and treatment, utilizes harm reduction strategies to address health concerns disproportionately affecting unhoused populations including HIV, hepatitis C, STIs, wounds, foot health, asthma, diabetes, substance use disorder, overdose risk, and behavioral health concerns.

Provide harm reduction services including naloxone, syringe and safer use supplies and education.

SUPERVISORY RESPONSIBILITIES :

This job has no supervisory responsibilities.