Remote Nursing Jobs • Critical Thinking

Ensure Mahmee members receive prompt, comprehensive, high-quality perinatal wraparound care. Candidates must have strong clinical knowledge and experience in providing clinical oversight, evidence-based risk assessment, and postpartum care. Responsibilities include proactively flagging health issues, managing hypertensive disorders, and conducting virtual visits.

The Care Manager is responsible for the coordination of services for members who meet established criteria, with an emphasis on education/self-management and promoting quality care and cost-effective outcomes. The Care Manager uses a collaborative process to assess Member needs, review options for services and resources, develop and implement a plan of care, coordinate resources, monitor progress, evaluate Member status, discharge Members, and fully document the individualized member care management process and outcome.

Apply critical thinking and evidence-based clinical criteria to evaluate inpatient and outpatient services requiring precertification. Conduct clinical reviews via phone and electronic documentation, collaborating with healthcare providers to gather necessary information. Use established guidelines to authorize services or escalate to Medical Directors as needed.