RN Care Manager

Company Description 

CareAbout Health is a managed services organization (MSO) that provides expert advice, resources, tools, and other support to its portfolio of medical groups and healthcare focused companies. CareAbout Health is helping align incentives to create a world where patients, providers, and payers work together in a seamless, coordinated manner toward common goals: higher quality, lower cost, better outcomes. 

Role Title: Care Manager, RN 

FLSA Category: Exempt 

Role Location: Hybrid (Boynton Beach, FL)

Reporting Relationships: 

This position reports to the Director of Care Management. 

Role Summary: 

The Care Manager, RN (CM-RN) will work on a multidisciplinary healthcare team in a primary care setting, focusing on coaching and coordination of care for patients needing navigation and follow up. The CM-RN will identify the needs of complex members and assist with the practice to develop processes for managing the high-risk member population. This person will promote patient-centered care, working with primary care providers and medical home team members. The CM-RN plays a key role in the transformation of the medical practice participating in VBC/APM contracts. 

Key Responsibilities / Essential Functions: 

• Develop constructive relationships with local hospitals admission offices, case managers and discharge planners.  
• Work to develop systems, processes, and initiatives to engage these entities in relevant case management activities with high-risk members of the practice ensuring necessary post discharge needs are met.  
• Monitor to ensure care is coordinated with home care agencies, specialists, or other resources needed. 
• Monitor to make sure follow-up primary care visits are obtained within 24 hours of hospital discharge. 
• Conduct follow-up to ensure that initial patient assessment and post-visit consultation includes a comprehensive medical, psychosocial, and that functional assessment of the patient are all completed and in order as identified by the patient centered medical home. 
• Communicate with and coach patients to ensure they are aware of discharge instructions, have necessary prescriptions, access to medications, and understand how to take the necessary medications, including what to look for regarding adverse events as per their care givers instructions. 
• Monitor that appropriate home care, hospice care, and other ancillary services (DME, infusion services etc.) are in place and are being delivered as directed by the care team. 
• Coordinate necessary referrals and authorizations within care management areas.  
• Facilitate the information flow between hospital, long-term care, specialists and home health representatives and the care team. 
• Work with physicians and office staff to help identify high risk, high need, and potentially high-cost patients. 
• Assist physicians and care team in implementing processes for best practices for preventive services, chronic care, and disease management. 
• Work collaboratively with physicians and the care team to ensure patient adherence to medical plan of care, including all appropriate preventive and disease-specific screenings, interventions, treatment goals – including self-management goals, and contract schedules. 
• Coordinate care and communicate with multiple providers, both within and external to the practice. 
• Identify and utilize cultural and community resources. 
• Verify that practice has necessary behavioral health screening tools (depression / substance abuse), and all members are receiving appropriate screening and behavioral health interventions. 
• Facilitate any necessary follow-up behavioral health needs with local behavioral health providers. 
• Attend required training and collaboration sessions [i.e., learning sessions, care management meetings, and practice team meetings] as scheduled. 
• Assess patient needs and develop a plan of action to address needs in collaboration with the primary care physician. 
• Provide and facilitate open communication, regarding patient status, with physicians and office staff. 
• Obtain records from other physicians/labs/diagnostic centers as requested by the physicians and as needed for care coordination efforts. 

Non-Essential Functions: 

• Other duties, as assigned. 

Qualifications: 

• Florida RN, degree, required. Must have a current Florida RN License.  
• Care Management experience preferred. 
• Certified Case Management (CCM) certification preferred. 
• APM (CPC+, BPCI, MSSP) and MA experience preferred. 
• Experience in acute inpatient, rehabilitation, sub-acute, skilled facility, home care, ambulatory care management, or managed health plan. 
• 5 years of direct patient care experience required. 

Role Requirements:  

• Principles of utilization management; Case/care management principles; Health care contracts and benefit eligibility requirements; Hospital structures and payment systems; Basic PC skills (MS Word/Outlook/PPT/Excel) 
• Ability to use independent judgment and to manage and impart confidential information. 
• Ability to analyze and solve problems requires details, data and facts that must be analyzed and challenged prior to making decisions. 
• Strong communication and interpersonal skills. 
• Ability to clearly communicate medical information to professional practitioners and/or the public. 
• Excellent organization, prioritization, follow up, analytical and time management skills with ability to handle multiple priorities and deadlines. 
• Good interpersonal skills, sense of urgency, being proactive and ownership for one’s work. 
• Dependable, with strong work ethic and extremely high degree personal integrity. 
• Ability to deal with multiple interruptions on a continual basis that must be met with a friendly exchange with others. 
• Ability to develop and implement new approaches to improve processes, procedures, or the general work environment. 
• Ability to review critical issues, effectively solve problems and create action plans. 

Physical Requirements: 

• Mainly sedentary. 
• Sitting at the desk most of the day. 
• Standing or walking less than two hours per day. 
• Lifting no more than ten pounds on rare occasions. 
• Must be able to work at a computer and answer phone calls on a regular basis. 

Compensation is based on the level and requirements of the role. 

Salary within our ranges may also be determined by your education, experience, knowledge, skills, abilities, and location, as required by the role, as well as internal equity and alignment with market data. 

CareAbout Health is committed to providing an environment of mutual respect where equal opportunities are available to all applicants and employees without regard to actual or perceived race, color, creed, religion, national origin, ancestry, citizenship status, age, sex or gender (including pregnancy, childbirth, related medical conditions and lactation), gender identity or gender expression (including transgender status), sexual orientation, marital status, military service and veteran status, disability, protected medical condition as defined by applicable state or local law, genetic information, or any other characteristic protected by applicable federal, state, or local laws and ordinances (referred to as “protected characteristics”).  

We are interested in every qualified candidate who is legally able to work in the United States without sponsorship. We cannot offer any visa sponsorship now at this time.