• Managing GHP Family Prenatal and Postpartum members • The RN Case Manager assesses, plans, implements, coordinates, monitors and evaluates all options and services with the goal of optimizing the patient or member's health status • Manages utilization and practice metrics to further refine the delivery of care model to maximize clinical, quality, and fiscal outcomes • Integrates evidence-based clinical guidelines, preventive guidelines, protocols, and other metrics in the development of treatment plans that are patient-centric, promoting quality and efficiency in the delivery of healthcare for the identified population • Develops systems of care that monitor progress and promote early intervention in acute care situations • Assesses the healthcare, educational and psychosocial needs of patients or members • Designs an individualized plan of care and fosters a team approach by working collaboratively with the patient or member, family, primary care provider, and other members of the health care team to ensure coordination of services • Continuously evaluates laboratory results, diagnostic tests, utilization patterns and other metrics to monitor quality and efficiency results for assigned population • Works to appropriately apply benefits and utilization management serving as a resource to the patient or member and healthcare team • Maintains required documentation for all case management activities