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Case Manager

3 months ago

Lakeland, United States Miami Beach Medical Group Full time
Job DescriptionJob Description

The Care Manager II facilitates patient care by overseeing the coordination and integration of health and care management functions to achieve a common goal. Care Managers II work alongside primary care physicians, specialists, psychologists, and social workers to optimize patients’ health and well-being, developing and implementing action plans to effectively treat patients. Care Manager II will act as resource for the Care Manager I and Care Coordinator.


Duties and Responsibilities:

  • Conduct assessments to identify individual needs and a specific care management plan to address objectives and goals identified during assessment(s) for patients enrolled in Care/Disease Management.
  • Evaluate Fall Risk PHQ-9, Health literacy, and risk of unplanned admission.
  • Coordinate pre-admission discharge and schedule admission.
  • Assist with identifying high-risk populations (i.e., high utilizers, multiple co-morbidities, polypharmacy, non-compliance, at risk for readmission, oxygen dependent, bed and wheelchair bound, etc...)
  • Monitor Homebound population and assist with home lab and home visit coordination.
  • Assist and coordinate care regarding medical urgencies, not limited to assisting with IVs, wound care, medication administration, etc.
  • Participate in Interdisciplinary Care Team (ICT) meetings with patient’s provider, health plan care manager, and pharmacy team member to communicate patient's progress with his/her treatment and discuss complex issues or barriers to care.
  • Educate the patient about the Hotline (Urgency Team), health plan benefits, CCMC services, and community resources.
  • Assess the patient for physical functional limitations, poor social support system, and behavioral health needs.
  • Assist in problem-solving with providers, utilization or service issues, prior authorization requests, and long-term care applications.
  • Ensure patient knowledge of medication compliance and reduce the risk of polypharmacy by providing education and support to help them better understand how to use their medication effectively.
  • Implement activities to promote cost savings, such as:
    1. Potentially prevent admissions by coordinating outpatient care
    2. Reduce readmissions (Target 10%)
    3. Improve Generic Dispensing Rate
  • Assist patients with coordinating care pertaining to HEDIS/Preventive health screenings. (Target 5 Stars in all Part C and Part D measures, 4 stars in Readmissions)
  • Resource for Care Manager I, Care Coordinator, and Clinic Staff


Qualifications/ Education / Licenses:

  • Associate degree in nursing required, bachelor’s degree preferred.
  • Active Registered Nurse license in Florida.
  • Three years of acute clinical experience required.
  • Three years of care or case management experience in hospital, health plan, or clinic setting required.
  • Proficient computer skills, including experience with Microsoft Excel, Word, and Outlook.
  • Strong written and verbal communication skills.
  • Excellent clinical assessment and analytical skills.
  • Bilingual in English and Spanish preferred.


At Clinical Care Medical Centers, we are committed to providing an environment of mutual respect where equal employment opportunities are available to all applicants and employees without regard to race, color, religion, sex, pregnancy, national origin, age, physical and mental disability, marital status, sexual orientation, gender identity, gender expression, military and veteran status, and any other characteristic protected by applicable law. Clinical Care Medical Centers believes that diversity and inclusion among our employees is critical to our success as a company. We support an inclusive workplace where employees excel based on personal merit, qualifications, experience, ability, and job performance.