South Florida Community Care Network LLC
Population Healthcare Management OB Care Coor
South Florida Community Care Network LLC, Fort Lauderdale, Florida, United States, 33323
Job Description
Job Description
Position Summary: The Population Health and Care Coordinator for Maternal Child Health plays a critical role as a core member of the care team, working closely with medical providers, maternal health specialists, and the broader care coordination team. This position is dedicated to overseeing the maternal child health population, coordinating, and supporting the physical and mental health care of enrollees within this population across various lines of business, including managed care contract programs. The coordinator’s primary responsibilities include managing healthcare interventions across the continuum of care, from complex medical needs to routine and preventative care, with a strong focus on improving maternal/child outcomes. This includes efforts to reduce unnecessary primary C-section rates, lower NICU admission rates, and decrease NICU stay durations. The role emphasizes closing immediate care gaps, facilitating safe and appropriate levels of care, and empowering members to self-manage their health, particularly in the context of chronic condition management and maternal care. By complementing the practitioner-patient relationship and supporting the established plan of care, the coordinator utilizes cost-effective, evidence-based practice guidelines aimed at enhancing the quality of life for mothers and children. Key objectives include addressing acute needs, preventing, or delaying the progression of conditions, and reducing complications and morbidities. Ultimately, the coordinator’s work contributes to improved health outcomes, including better maternal and neonatal results, and reduced healthcare costs. All job functions are performed in accordance with the requirements of Medicaid contracts, Florida Healthy Kids (FHK) contracts, Community Care Plan (CCP) policies and procedures, and Patient-Centered Medical Home (PCMH) standards. Essential Duties and Responsibilities: Client Intake and Assessment: Complete client intake on all referred or identified pregnant members across multiple lines of business, securing agreement to program participation. Conduct initial needs assessments to evaluate medical, psychosocial, and educational needs, and ensure a risk stratification is completed to determine level of care requirements. Develop individualized care plans that address medical, educational, and psychosocial needs, incorporating the enrollee and family in the care planning process. Care Coordination and Follow-Up: Provide routine follow-up contact with enrollees and providers to ensure appointment compliance based on the level of care requirements. Ensure enrollees have an established medical home or assist in obtaining primary healthcare for both self and newborn, if needed. Provide care management throughout the entire pregnancy term, facilitating post-partum visits and the first well-baby examination to ensure linkage to ongoing primary care. Education and Intervention: Create intervention and educational plans covering pregnancy knowledge, self-care behaviors, lifestyle counseling, and referral to community resources as applicable. Develop and provide educational materials suited to enrollees' educational levels, and review these with the enrollee/caregiver and healthcare provider. Care Monitoring and Coordination: Monitor clinical outcomes, ensuring appropriately timed medical care, lab work, and self-monitoring, and assist with scheduling and compliance. Evaluate treatment plans, referring patients to contracted providers or community organizations as appropriate. Coordinate with community resources such as Healthy Start, WIC, SNAP, and others to support the health of the mom and newborn. Specialty Care and Screening: Facilitate maternity care, ensuring compliance with screening and referral for HIV, Hepatitis B, and other requirements. Ensure obstetrical care providers offer clients Florida's Healthy Start Prenatal and Postnatal screenings in accordance with Florida Statutes. Notify the local county health department of any pregnant enrollee testing positive for Hepatitis B and report to state and local agencies on pregnancy and births as per contractual requirements. Quality Improvement and Compliance: Coordinate with the Quality Improvement Department to collect necessary data and implement initiatives to meet or improve established benchmarks for obstetric-related quality HEDIS measures. Maintain individual client records, ensuring compliance with Federal and State guidelines and standards, and maintain confidential medical records for each patient. Refer to the Medical Director any questionable, quality, or inappropriate treatment regimen and/or care. Communication and Collaboration: Interact with, assist, and educate physicians, hospital representatives, administrators, patients and their families, corporate representatives, and other healthcare providers regarding the High-Risk Pregnancy Management Program. Maintain professional relationships with external agencies such as AHCA, FHK, and Community Services, serving as an ombudsman as needed. Additional Responsibilities: Participate in in-service training programs to enhance professional skills and knowledge. Assist in the coordination of services for transportation, food, shelter, finance, and mental health as identified. This job description in no way states or implies that these are the only duties performed by the employee occupying this position. Employees will be required to perform any other job-related duties assigned by their supervisor or management. Qualifications: Bachelor’s Degree in Nursing. Master’s Degree in Nursing (Preferred)
Certificates and Licenses: Registered Nurse licensure in the state of Florida Certified Case Manager (Preferred) Experience: Clinical Experience:
3-5 years of clinical experience including labor and delivery, high risk antepartum and NICU. Experience in Managed Care/Health Plan Setting : 3-5 years of experience in a managed care, health plan, or insurance setting, particularly in maternal health or disease/case management roles. Experience with Utilization Management and Care Coordination : Experience coordinating care across medical, maternal/child, and social service providers, including familiarity with utilization management processes, appeals, and authorizations. Knowledge of Medicaid/Medicare Regulations : Experience working with Medicaid, Medicare, or other state and federal health care programs, including knowledge of relevant regulations and compliance requirements. Knowledge of Microsoft Office and internet software Knowledge of EPIC and/or JIVA (preferred) Skills and Abilities: Clinical Knowledge and Expertise: Strong understanding of maternal and child health, including high-risk pregnancy management, prenatal and postnatal care, and common complications. Knowledge of evidence-based practices and guidelines in maternal and child health, including breastfeeding promotion, nutritional assessments, and preventive screenings. Care Coordination Skills: Proven ability to coordinate care across multiple providers and settings, ensuring seamless integration of services for mothers and newborns. Experience in developing individualized care plans, monitoring progress, and adjusting care strategies as needed. Proficient in assessing and managing the psychosocial, educational, and medical needs of pregnant members and their newborns. Communication and Interpersonal Skills: Exceptional oral and written communication skills, including the ability to effectively engage and educate enrollees, families, and healthcare providers. Strong interpersonal skills with the ability to build and maintain effective, professional relationships with enrollees, care teams, and community resources. Ability to speak effectively before groups, including enrollees, healthcare professionals, and community stakeholders. Problem-Solving and Critical Thinking: Demonstrated ability to assess complex situations, identify barriers to care, and develop creative solutions to improve health outcomes. Strong analytical skills to evaluate data, track clinical outcomes, and implement care strategies that reduce risks and enhance patient care. Organizational and Time Management Skills: Highly organized with the ability to manage a diverse caseload, prioritize tasks, and follow through on assignments to successful completion. Skilled in maintaining detailed and accurate documentation, adhering to compliance standards, and managing confidential information in line with HIPAA guidelines. Cultural Competence and Sensitivity: Ability to work effectively with diverse populations, demonstrating sensitivity to cultural, socio-economic, and educational differences. Proficient in engaging enrollees from varied backgrounds, tailoring communication and education strategies to meet their specific needs. Teamwork and Collaboration: Ability to work collaboratively in a multidisciplinary team environment, contributing to team huddles, care planning meetings, and quality improvement initiatives. Skilled in building cross-functional teams and fostering collaboration among care providers, community resources, and other stakeholders. Technical Proficiency: Proficient with electronic health records (EHR) and care management software to document care, track progress, and communicate with care teams. Comfortable using technology, including telephonic and virtual platforms, to engage with enrollees and coordinate care. Motivational Interviewing and Patient Engagement: Experience with motivational interviewing techniques and strategies to empower enrollees in self-management and adherence to care plans. Ability to provide patient-centered education, support shared decision-making, and promote healthy lifestyle changes. Adaptability and Flexibility: Ability to adapt to changing priorities and healthcare environments, maintaining a high level of performance under pressure. Willingness to travel as needed within the community and to various care settings to support enrollees and care teams. Compliance and Quality Focus: Knowledge of accreditation requirements and standards related to maternal child health programs and care coordination. Commitment to maintaining compliance with quality standards, policies, and procedures, ensuring that all care activities meet or exceed regulatory guidelines. Physical Demands: The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. While performing the duties of this job, the employee is regularly required to sit, use hands, reach with hands and arms, and talk or hear. The employee is frequently required to stand, walk, and sit. The employee is occasionally required to stoop, kneel, crouch or crawl. The employee may occasionally lift and/or move up to 15 pounds. Work Schedule:
Community Care Plan is currently following a hybrid work schedule. The company reserves the right to change the work schedules based on the company needs. Work Environment: The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of the job. The environment includes work inside/outside the office, travel to other offices, as well as domestic, travel. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. The noise level in the work environment is usually moderate. We are an equal opportunity employer who recruits, employs, trains, compensates and promotes regardless of age, color, disability, ethnicity, family or marital status, gender identity or expression, language, national origin, physical and mental ability, political affiliation, race, religion, sexual orientation, socio-economic status, veteran status, and other characteristics that make our employees unique. We are committed to fostering, cultivating, and preserving a culture of diversity, equity and inclusion.
Job Description
Position Summary: The Population Health and Care Coordinator for Maternal Child Health plays a critical role as a core member of the care team, working closely with medical providers, maternal health specialists, and the broader care coordination team. This position is dedicated to overseeing the maternal child health population, coordinating, and supporting the physical and mental health care of enrollees within this population across various lines of business, including managed care contract programs. The coordinator’s primary responsibilities include managing healthcare interventions across the continuum of care, from complex medical needs to routine and preventative care, with a strong focus on improving maternal/child outcomes. This includes efforts to reduce unnecessary primary C-section rates, lower NICU admission rates, and decrease NICU stay durations. The role emphasizes closing immediate care gaps, facilitating safe and appropriate levels of care, and empowering members to self-manage their health, particularly in the context of chronic condition management and maternal care. By complementing the practitioner-patient relationship and supporting the established plan of care, the coordinator utilizes cost-effective, evidence-based practice guidelines aimed at enhancing the quality of life for mothers and children. Key objectives include addressing acute needs, preventing, or delaying the progression of conditions, and reducing complications and morbidities. Ultimately, the coordinator’s work contributes to improved health outcomes, including better maternal and neonatal results, and reduced healthcare costs. All job functions are performed in accordance with the requirements of Medicaid contracts, Florida Healthy Kids (FHK) contracts, Community Care Plan (CCP) policies and procedures, and Patient-Centered Medical Home (PCMH) standards. Essential Duties and Responsibilities: Client Intake and Assessment: Complete client intake on all referred or identified pregnant members across multiple lines of business, securing agreement to program participation. Conduct initial needs assessments to evaluate medical, psychosocial, and educational needs, and ensure a risk stratification is completed to determine level of care requirements. Develop individualized care plans that address medical, educational, and psychosocial needs, incorporating the enrollee and family in the care planning process. Care Coordination and Follow-Up: Provide routine follow-up contact with enrollees and providers to ensure appointment compliance based on the level of care requirements. Ensure enrollees have an established medical home or assist in obtaining primary healthcare for both self and newborn, if needed. Provide care management throughout the entire pregnancy term, facilitating post-partum visits and the first well-baby examination to ensure linkage to ongoing primary care. Education and Intervention: Create intervention and educational plans covering pregnancy knowledge, self-care behaviors, lifestyle counseling, and referral to community resources as applicable. Develop and provide educational materials suited to enrollees' educational levels, and review these with the enrollee/caregiver and healthcare provider. Care Monitoring and Coordination: Monitor clinical outcomes, ensuring appropriately timed medical care, lab work, and self-monitoring, and assist with scheduling and compliance. Evaluate treatment plans, referring patients to contracted providers or community organizations as appropriate. Coordinate with community resources such as Healthy Start, WIC, SNAP, and others to support the health of the mom and newborn. Specialty Care and Screening: Facilitate maternity care, ensuring compliance with screening and referral for HIV, Hepatitis B, and other requirements. Ensure obstetrical care providers offer clients Florida's Healthy Start Prenatal and Postnatal screenings in accordance with Florida Statutes. Notify the local county health department of any pregnant enrollee testing positive for Hepatitis B and report to state and local agencies on pregnancy and births as per contractual requirements. Quality Improvement and Compliance: Coordinate with the Quality Improvement Department to collect necessary data and implement initiatives to meet or improve established benchmarks for obstetric-related quality HEDIS measures. Maintain individual client records, ensuring compliance with Federal and State guidelines and standards, and maintain confidential medical records for each patient. Refer to the Medical Director any questionable, quality, or inappropriate treatment regimen and/or care. Communication and Collaboration: Interact with, assist, and educate physicians, hospital representatives, administrators, patients and their families, corporate representatives, and other healthcare providers regarding the High-Risk Pregnancy Management Program. Maintain professional relationships with external agencies such as AHCA, FHK, and Community Services, serving as an ombudsman as needed. Additional Responsibilities: Participate in in-service training programs to enhance professional skills and knowledge. Assist in the coordination of services for transportation, food, shelter, finance, and mental health as identified. This job description in no way states or implies that these are the only duties performed by the employee occupying this position. Employees will be required to perform any other job-related duties assigned by their supervisor or management. Qualifications: Bachelor’s Degree in Nursing. Master’s Degree in Nursing (Preferred)
Certificates and Licenses: Registered Nurse licensure in the state of Florida Certified Case Manager (Preferred) Experience: Clinical Experience:
3-5 years of clinical experience including labor and delivery, high risk antepartum and NICU. Experience in Managed Care/Health Plan Setting : 3-5 years of experience in a managed care, health plan, or insurance setting, particularly in maternal health or disease/case management roles. Experience with Utilization Management and Care Coordination : Experience coordinating care across medical, maternal/child, and social service providers, including familiarity with utilization management processes, appeals, and authorizations. Knowledge of Medicaid/Medicare Regulations : Experience working with Medicaid, Medicare, or other state and federal health care programs, including knowledge of relevant regulations and compliance requirements. Knowledge of Microsoft Office and internet software Knowledge of EPIC and/or JIVA (preferred) Skills and Abilities: Clinical Knowledge and Expertise: Strong understanding of maternal and child health, including high-risk pregnancy management, prenatal and postnatal care, and common complications. Knowledge of evidence-based practices and guidelines in maternal and child health, including breastfeeding promotion, nutritional assessments, and preventive screenings. Care Coordination Skills: Proven ability to coordinate care across multiple providers and settings, ensuring seamless integration of services for mothers and newborns. Experience in developing individualized care plans, monitoring progress, and adjusting care strategies as needed. Proficient in assessing and managing the psychosocial, educational, and medical needs of pregnant members and their newborns. Communication and Interpersonal Skills: Exceptional oral and written communication skills, including the ability to effectively engage and educate enrollees, families, and healthcare providers. Strong interpersonal skills with the ability to build and maintain effective, professional relationships with enrollees, care teams, and community resources. Ability to speak effectively before groups, including enrollees, healthcare professionals, and community stakeholders. Problem-Solving and Critical Thinking: Demonstrated ability to assess complex situations, identify barriers to care, and develop creative solutions to improve health outcomes. Strong analytical skills to evaluate data, track clinical outcomes, and implement care strategies that reduce risks and enhance patient care. Organizational and Time Management Skills: Highly organized with the ability to manage a diverse caseload, prioritize tasks, and follow through on assignments to successful completion. Skilled in maintaining detailed and accurate documentation, adhering to compliance standards, and managing confidential information in line with HIPAA guidelines. Cultural Competence and Sensitivity: Ability to work effectively with diverse populations, demonstrating sensitivity to cultural, socio-economic, and educational differences. Proficient in engaging enrollees from varied backgrounds, tailoring communication and education strategies to meet their specific needs. Teamwork and Collaboration: Ability to work collaboratively in a multidisciplinary team environment, contributing to team huddles, care planning meetings, and quality improvement initiatives. Skilled in building cross-functional teams and fostering collaboration among care providers, community resources, and other stakeholders. Technical Proficiency: Proficient with electronic health records (EHR) and care management software to document care, track progress, and communicate with care teams. Comfortable using technology, including telephonic and virtual platforms, to engage with enrollees and coordinate care. Motivational Interviewing and Patient Engagement: Experience with motivational interviewing techniques and strategies to empower enrollees in self-management and adherence to care plans. Ability to provide patient-centered education, support shared decision-making, and promote healthy lifestyle changes. Adaptability and Flexibility: Ability to adapt to changing priorities and healthcare environments, maintaining a high level of performance under pressure. Willingness to travel as needed within the community and to various care settings to support enrollees and care teams. Compliance and Quality Focus: Knowledge of accreditation requirements and standards related to maternal child health programs and care coordination. Commitment to maintaining compliance with quality standards, policies, and procedures, ensuring that all care activities meet or exceed regulatory guidelines. Physical Demands: The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. While performing the duties of this job, the employee is regularly required to sit, use hands, reach with hands and arms, and talk or hear. The employee is frequently required to stand, walk, and sit. The employee is occasionally required to stoop, kneel, crouch or crawl. The employee may occasionally lift and/or move up to 15 pounds. Work Schedule:
Community Care Plan is currently following a hybrid work schedule. The company reserves the right to change the work schedules based on the company needs. Work Environment: The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of the job. The environment includes work inside/outside the office, travel to other offices, as well as domestic, travel. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. The noise level in the work environment is usually moderate. We are an equal opportunity employer who recruits, employs, trains, compensates and promotes regardless of age, color, disability, ethnicity, family or marital status, gender identity or expression, language, national origin, physical and mental ability, political affiliation, race, religion, sexual orientation, socio-economic status, veteran status, and other characteristics that make our employees unique. We are committed to fostering, cultivating, and preserving a culture of diversity, equity and inclusion.