Nurse Case Manager

Nurse Case Manager

Job Description

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

Duties:
Applies critical thinking, evidence-based clinical criteria to support contractual rebalancing goals.
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

Experience

Experience Required:
Minimum 2 years of clinical experience
Bi-Lingual Spanish/ English required.
Willing and able to travel 75% of their time to meet members face to face and surrounding counties/areas.

Preferred Skills:
Managed Care experience-Discharge coordination experience
Transition of care experience-Home Health experience
Case Management experience
Position requires proficiency with computer skills which includes navigating multiple systems
Ability to work in a fast-paced environment

Experience Level:
Specify the level of experience required mid-level

Education:
Education/Licensure: Active, unrestricted and good standing RN license in FL.
Education: Associate Degree Required and BSN preferred.

Notes:
Hours required are M - F 8am - 5 pm EST with some flexibility for start/ stop times.
Local travel up to 75%.

VIVA is an equal opportunity employer. All qualified applicants have an equal opportunity for placement, and all employees have an equal opportunity to develop on the job. This means that VIVA will not discriminate against any employee or qualified applicant on the basis of race, color, religion, sex, sexual orientation, gender identity, national origin, disability or protected veteran status.