Clinical - Care Manager I (RN)
2 weeks ago
Remote, FL market; compact RN license is required.
Job Description: Description - External
Position Purpose: Perform care management duties to assess, plan and coordinate all aspects of medical and supporting services across the continuum of care for select members to promote quality, cost effective care
" Develop, assess and adjust, as necessary, the care plan and promote desired outcome
" Assess the member's current health status, resource utilization, past and present treatment plan and services, prognosis, short and long term goals, treatment and provider options
" Coordinate services between Primary Care Physician (PCP), specialists, medical providers, and non-medical staff as necessary to meet the complete medical socio economic needs of clients
" Develop plan of care based upon assessment with specific objectives, goals and interventions designed to meet member's needs
" Provide patient and provider education
" Facilitate member access to community based services
" Monitor referrals made to community based organizations, medical care and other services to support the members overall care management plan
" Actively participate in integrated team care management rounds
" Identify related risk management quality concerns and report these scenarios to the appropriate resources
" Enter and maintain assessments, authorizations, and pertinent clinical information into various medical management systems
Qualifications - External
Education/Experience: Graduate from an Accredited School of Nursing. Bachelor s degree in Nursing preferred. 2+ years of pediatric clinical nursing experience in a clinical, acute care, or community setting. Knowledge of healthcare and managed care preferred. Florida residency required. Knowledge of healthcare and managed care preferred. Prior experience working in a remote role preferred. Prior case management experience preferred. Bilingual in Spanish and English is preferred.
Licenses/Certifications: Current state s RN license.
*Pediatrics - birth to 21
*Work-from-home case management role
Walk me through the day-to-day responsibilities of this the role and a description of the project
- Remote telephonic case management, Care manager (CM) follows model of care to assist member in managing health care needs.
- Conducts initial assessments, medication review, develops care plan with member, identifies member needs and connects member with appropriate resources to meet health care needs.
- Interacts with members care team, community services, vendors.
- Follows up with member every 30 days at minimum to review conditions, progress toward goals, and ensure member is receiving requested information and/or services.
- Provides education on member health plan and coverage and management of identified health conditions.
- CM caseload expectation is 75 actively managed members, Audit score of 90%or greater, Case duration 90 days.
- First day is usually corporate HR training, Setting up company issued equipment and access necessary to perform role specific duties.
- RN, experience in case management preferred, clinical nursing background of 5 years or more.
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