Nurse Case Manager

Nurse Case Manager

  Not Disclosed

  Tallahassee, FL

  6 Months

  Not Disclosed

  Not Disclosed

  Healthcare

  $32.98/hour - $37.98/hour

Job Description

Description:

· Complete at least 10 NF member assessments weekly
·Support the Health Plan Rebalancing Initiative goal of successful transitions: Assess, identify, screen and transition NH members into the community
· Follow up on CM referrals and visit current NH members in-person at least twice a week to complete the rebalancing events and screening assessments.
· Complete telephonic or in-person contact to assess the home prior to discharge and identify any environmental supports needed to support transition (i.e. ramp, DME installation etc.).
Conduct an in-person Significant Change Visit with member and Rep if applicable, within 5 days of transition. Coordinate provision of services as needed, establish Plan of Care, and document all actions taken.
· Contact facility’s Business Office once a week to follow-up on mbr’s census and will coordinate with Social Services and CM to facilitate discharge.
· Work collaboratively with case managers to identify high risk community members and implement appropriate interventions to prevent lapse or coordinate safe transition (Upon receiving referral)
· Drive enhanced value of health care to increase member satisfaction and retention, and drive new membership growth.
· Be involved in at least two community relations event per year
· Engage in building strong relationships that contribute towards member satisfaction and retention


Duties
Through the use of clinical tools and information/data review, conducts comprehensive assessments of referred member's needs/eligibility and determines approach to case resolution and/or meeting needs by evaluating member's benefit plan and available internal and external programs/services
Application and/or interpretation of applicable criteria and guidelines, standardized case management plans, policies, procedures, and regulatory standards while assessing benefits and/or member’s needs to ensure appropriate
administration of benefits
Utilizes case management and quality management processes in compliance with regulatory and accreditation guidelines and company policies and procedures
Experience
3 years Clinical practice experience, e.g., hospital setting, alternative care setting such as home health or ambulatory care required.
Healthcare and/or managed care industry experience.
Case Management experience preferred-- Position requires proficiency with computer skills which includes navigating multiple systems and keyboarding
Effective communication skills, both verbal and written.
Ability to multitask, prioritize and effectively adapt to a fast paced changing environment
Sedentary work involving periods of sitting, talking, listening. Work requires sitting for extended periods, talking on the telephone and typing on the computer.
Work requires the ability to perform close inspection of hand written and computer generated documents as well as a PC monitor.
Typical office working environment with productivity and quality expectations?

Position Summary
The Case Manager utilizes a collaborative process of assessment, planning, facilitation and advocacy for options and services to meet an individual’s benefit plan and/or health needs through communication and available resources to promote optimal, cost-effective outcomes.

Requires an RN with unrestricted active license

Education
RN with current unrestricted state licensure in FL or Valid COMPACT License.
Case Management Certification CCM preferred


Notes:

Mon-Fri 8am-5pm EST

Hours required are M - F 8am - 5 pm EST with some flexibility for start/ stop times. Local travel up to 75%. Applies critical thinking, evidence-based clinical criteria to support contractual rebalancing goals.