RN Care Manager

4 weeks ago

Margate, Florida, United States Centers Plan for Healthy Living Full time

RN Care Manager (Hybrid)

5297 W Copans Rd, Margate, FL 33063, USA

Req #525

Monday, June 3, 2024

Care Solutions' goal is to create the ultimate healthcare experience that provides our members, their families, healthcare decision makers, and general caregivers with the guidance and plans they need for healthy living.

Primary Responsibilities:

  • Provides case management through telephonic assessments, care planning, implementation, care coordination, monitoring and evaluation to ensure member receives services and supports required to meet psychosocial, educational and health care needs
  • Develops, facilitates, and communicates a plan of care in partnership with the member, his/her significant other, primary caregiver, the primary and attending physicians, and various other providers involved in the member's care.
  • Initiates utilization review for preauthorization and post service reviews
  • Utilizes knowledge of community resources and the member's benefit structure
  • Interacts with providers and facilities in a professional, respectful manner
  • Recognizes quality of care issues and escalates the issues appropriately
  • Assists members with the coordination of services from various settings as appropriate
  • appropriate
  • Complies with all CCSs standards for documentation
  • Participates in case rounds
  • Participates in on call coverage
  • Participates in other meetings as requested
  • Participates in quality improvement initiatives
  • Other duties as assigned Required:
  • Strong written and verbal communication skills Preferred:
  • Bachelor of Science in Nursing
  • CCM certification
  • Knowledge of Milliman or InterQual criteria
  • Experience providing care in the home setting
  • Experience working within a managed care environment

We offer:

  • Hybrid schedule (for employees who qualify)

Care Solutions is committed to leveraging the diverse backgrounds, perspectives and experiences of our workforce to create opportunities for our employees and our business. We are an equal opportunity employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, disability, protected veteran status or any other characteristic protected by law and will not be denied employment.

Other details

  • Pay Type Salary

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  • 5297 W Copans Rd, Margate, FL 33063, USA

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