Location: Columbia, MD
Cap-Exempt H-1B Position — No lottery required
About this Job: **General Summary of Position** The RN High Risk Case Manager supports high-risk antepartum and postpartum patients through comprehensive care coordination across the continuum. This role focuses on managing complex pregnancies, ensuring timely access to care, and promoting healthy maternal and infant outcomes through education, close monitoring, and proactive follow-up. Working collaboratively with providers and an interdisciplinary team, the RN Case Manager guides patients through treatment plans, addresses clinical and social needs, and helps reduce complications and avoidable readmissions . Responsible for carrying a complex case management case load ownership of a case management program(s) pre- authorization reviews to provide Medically Necessary timely and quality health care services in the most cost-effective manner and pharmacy reviews per population served. We recruit retain and advance associates with diverse backgrounds skills and talents equitably at all levels. **Primary Duties and Responsibilities** - 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. - Actively develops and manages complex case management cases and develops individualized plans of care according to NCQA standards/ guidelines and the District of Columbia Contract. - Acts as a liaison to MedStar Family Choice contracted vendors to facilitate care. Identifies gaps in contracted services and develops a plan to access care. - Acts as an advocate while assisting members/enrollees to coordinate and gain access to medical psychiatric psychosocial and other essential services to meet their healthcare needs. Authorizes and monitors covered services according to policy. - Assists hospital case management staff with discharge planning if applicable. Makes recommendation to alternate tier of Case Management prog