Managed Care Coord
1 month ago
Location: The ideal candidate will live within 50 miles of a Florida Elevance Health Pulse Point office Shift: Monday – Friday; 8:00am – 7:00pm; some weekends; Schedule will flex The Managed Care Coordinator – RN Clinician is responsible for overall management of member’s case within the scope of licensure; provides supervision and direction to non-RN clinicians participating in the member’s case in accordance with applicable state law and contract; develops, monitors, evaluates, and revises the member’s care plan to meet the member’s needs, with the goal of optimizing member health care across the care continuum. How you will make an impact: Responsible for performing telephonic or face-to-face clinical assessments for the identification, evaluation, coordination and management of member’s needs, including physical health, behavioral health, social services and long-term services and supports. Identifies members for high-risk complications and coordinates care in conjunction with the member and the health care team. Manages members with chronic illnesses, co-morbidities, and/or disabilities, to insure cost effective and efficient utilization of health benefits. Obtains a thorough and accurate member history to develop an individual care plan. Establishes short- and long-term goals in collaboration with the member, caregivers, family, natural supports, physicians; identifies members that would benefit from an alternative level of care or other waiver programs. The RN has overall responsibility to develop the care plan for services for the member and ensures the member’s access to those services. May assist with the implementation of member care plans by facilitating authorizations/referrals for utilization of services, as appropriate, within benefits structure or through extra-contractual arrangements, as permissible. Interfaces with Medical Directors, Physician Advisors, and/or Inter-Disciplinary Teams on the development of care management treatment plans. May also assist in problem solving with providers, claims or service issues. Directs and/or supervises the work of any LPN/LVN, LSW, LCSW, LMSW, and other licensed professionals other than an RN, in coordinating services for the member by, for example, assigning appropriate tasks to the non-RN clinicians, verifying and interpreting member information obtained by these individuals, conducting additional assessments, as necessary, to develop, monitor, evaluate, and revise the member’s care plan to meet the member’s needs, and reviewing and providing input on the non-RN clinicians performance on a regular basis. Minimum Requirements: Requires an RN and minimum of 3 years of experience in working with individuals with chronic illnesses, co-morbidities, and/or disabilities in a Service Coordinator, Case Management, or similar role; or any combination of education and experience, which would provide an equivalent background. Current, unrestricted RN license in applicable state(s) required. Preferred skills, capabilities, and experiences: MA/MS in Health/Nursing preferred. May require state-specified certification based on state law and/or contract. Travels to worksite and other locations, as necessary.
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Managed Care Coord
1 month ago
North Miami Beach, United States Elevance Health Full timeManaged Care Coord - RN Clinician Description Location: The ideal candidate will live within 50 miles of a Florida Elevance Health Pulse Point office Shift: Monday - Friday; 8:00am - 7:00pm; some weekends; Schedule will flex The Managed Care Coordinator - RN Clinician is responsible for overall management of member's case within the scope of licensure;...
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Clinical Nurse Coord RN
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Pompano Beach, United States HCA Florida Northwest Hospital Full timeJob DescriptionDescription IntroductionDo you have the career opportunities as a(an) Clinical Nurse Coord RN you want in your current role? We invest in what matters most to nurses like you – at home, at work, and at every stage in your career. We have an exciting opportunity for you to join HCA Florida Northwest Hospital which is a part of the nation’s...
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Clinical Nurse Coord RN
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Pompano Beach, United States HCA Florida Northwest Hospital Full timeJob DescriptionDescription IntroductionDo you have the career opportunities as a(an) Clinical Nurse Coord RN you want in your current role? We invest in what matters most to nurses like you – at home, at work, and at every stage in your career. We have an exciting opportunity for you to join HCA Florida Northwest Hospital which is a part of the nation’s...
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Clinical Nurse Coord RN
2 weeks ago
Pompano Beach, FL, United States HCA Florida Northwest Hospital Full timeJob DescriptionDescription IntroductionDo you have the career opportunities as a(an) Clinical Nurse Coord RN you want in your current role? We invest in what matters most to nurses like you – at home, at work, and at every stage in your career. We have an exciting opportunity for you to join HCA Florida Northwest Hospital which is a part of the nation’s...
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RN LifeFlight Outreach Coord.
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Miami, FL, United States Nicklaus Children's Hospital Full timeRN LifeFlight Outreach Coord. (Full Time)Job Summary The RN LifeFlight Outreach Coordinator is responsible for customer relationship building that leads to positioning the Nicklaus Children's Hospital's LifeFlight program and Nicklaus Children's Hospital as the provider of choice for regional transport referrals. Evaluates the healthcare market and regional...
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RN Clinical Care Manager
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RN LifeFlight Outreach Coord.
1 month ago
Miami, Florida, United States Nicklaus Children's Health System Full timeJob SummaryThe RN LifeFlight Outreach Coordinator is responsible for customer relationship building that leads to positioning the Nicklaus Children's Hospital's LifeFlight program and Nicklaus Children's Hospital as the provider of choice for regional transport referrals. Evaluates the healthcare market and regional transport needs, monitors and trends...