RN Case Manager Maternal Infant Program Job Listing at MedStar Health in Columbia, MD (Job ID 157843)

Description

About the Job

General Summary of Position
The RN Manager Maternal Infant Program serves as the operational and clinical lead for Medstar Family Choice's maternal and infant health programs ensuring coordinated high-quality and equitable support for pregnant postpartum members and infants. This role manages the success of our internal maternal case management and support initiatives while serving as the primary liaison to external maternal care partners.The ideal candidate is an experienced Maternal Health Registered Nurse (RN) who combines strong clinical judgment with data-driven decision making. They will evaluate program performance drive collaboration across internal and external teams and continuously improve member experience and outcomes across the maternal journey.

Primary Duties and Responsibilities

• Program Management & Oversight: Leads the strategy implementation and continuous improvement of Medstar Family Choice's maternal case management and member support programs. Ensures maternal program design aligns with state and federal Medicaid requirements NCQA standards and quality improvement goals. Monitors program capacity and impact proactively identifying barriers to engagement or care coordination and communicating performance & risks to senior leadership. Creates alignment across internal and external teams to ensure every pregnant and postpartum member receives coordinated person-centered care.
• Cross-Functional & Vendor Collaboration: Serves as the point of contact and collaborative partner for maternal health vendors. Facilitates effective data sharing reporting and communication between internal teams (clinical quality analytics compliance provider & outreach) and vendor partners. Leads joint case reviews program meetings and workflow refinement discussions to optimize member experience and avoid duplication of services.
• Data Quality & Outcomes: Analyzes data related to member engagement outcomes and utilization to evaluate program effectiveness. Partners with analytics and quality teams to develop dashboards metrics and reports tracking maternal program KPIs. Translates data insights into actionable program improvements and best practice recommendations.
• Clinical Leadership: Provides clinical insight into maternal care pathways and care coordination strategies for high-risk and complex members. Serves as a subject matter expert on maternal health bringing evidence-based practices and member-centered approaches to the plan's broader care strategy. Contributes to the achievement of established department goals and objectives and adheres to department policies procedures quality standards and safety standards. Complies with governmental and accreditation regulations. Demonstrates behavior consistent with MedStar Health mission vision goals objectives and patient care philosophy. Maintains current knowledge about and acts in accordance with procedures regarding member confidentiality principles of consent and Advanced Directives. Maintains current knowledge of benefits claims and enrollment issues. Provides ongoing individual coaching and support to staff. Selects trains orients and assigns work for direct reports. Assists with the development of performance standards evaluates performance and conducts performance management planning. Initiates or makes recommendations for personnel actions. Maintains ongoing communication with subordinates to review progress provide feedback discuss new developments and exchange information. Adheres to the fundamental duties of a manager with direct reports. Collaborates with and serves as a point of contact for state regulators on maternity program requirements reporting and compliance.

Minimal Qualifications
Education

• Bachelor's degree Nursing Public Health or related field preferred

Experience

• 5-7 years Experience in care management maternal health or population health within Medicaid or managed care settings. required and
• 5-7 years Diverse clinical experience required and
• 1-2 years 2 years supervisory experience preferred

Licenses and Certifications

• RN - Registered Nurse - State Licensure and/or Compact State Licensure Valid RN license in the State of Maryland and the District of Columbia Upon Hire required

Knowledge Skills and Abilities

• Effective verbal and written communication skills.
• Ability to follow verbal and written instructions.
• Proficient computer with Microsoft Office applications especially Word Excel and PowerPoint.
• Ability to enter and retrieve information using a PC.
• Working knowledge of various computer software applications.
• Knowledge of current trends in health care delivery and population management.
• Knowledge of NCQA HEDIS InterQual and local regulatory guidelines preferred.
• Proven ability to interpret and act on program and population-level data.
• Experience collaborating across payer provider and vendor teams.
• Excellent communication problem-solving and stakeholder management skills.
• Strong understanding of health equity member engagement and maternal health quality metrics (e.g. HEDIS NCQA CMS core sets).