Case Manager RN -Remote

What is your purpose:
This key position is responsible for assisting members who live within the State of Florida and who are experiencing a complex illness and/or condition. These members require significant resources focused on their treatment plan and beyond, as we assist them in making effective health care choices moving them towards self-management; and/or helping them access Palliative/Hospice services as needed. Utilizing a member-centric approach, assist members and their families to understand and manage their disease process by reinforcing the physicians' plan of treatment, coordinating services within the benefit plan, collaborating with the treatment team, promoting healthy behaviors and lifestyle changes as needed, and providing education and tools to promote self- management to improve health outcomes and reduce overall costs. Individual care plans are developed in collaboration with the Physician, Member/Care Giver, Families, and the Care Team. Ongoing coaching, monitoring and evaluation of care plans will be done face to face with the member, telephonically or electronically through email and member and provider portals.

What are your key responsibilities:
Engage Members telephonically with a focus on health coaching and member education. Facilitate access to care and resources to meet the member's health care needs. Provide education and tools to promote self-management.
Completed detailed and comprehensive initial clinical assessment and monthly re-assessments while adjusting the member plan of care and removing barriers to the treatment plan and/or access to care, services and achieving quality of life.
Plan, implement, coordinate, and monitor Case Management activities that may include acute and non-acute services, outpatient services and or community resources.
Facilitate care for Complex High-Risk members across the continuum of the health care experience, including care transitions, coordination of community and social service and coordinating with other value-based organizations, providers as needed.
Conditions managed will include members who are progressing to organ failure and proceed to Organ Transplantation and/or targeted treatment plans such as CAR-T.
Working in partnership with the member to develop a Plan of Care for the Complex member that requires frequent updating and moves towards a focus on self-management.

What is required:
2 years related work experience or equivalent combination of transferable experience and education. Experience Details: Communicating and building relationships with members/providers/employers both telephonically as well as in person as appropriate
RN - Registered Nurse - State Licensure -Obtain Compact State Licensure upon hire
CCM - Certified Case Manager or willingness to obtain within one year
Experience in working with individuals who have complex and/or catastrophic illness and treatment plans that include Solid Organ Transplant and Oncology with focus on CAR-T
Experience with influencing and motivating individuals to change health behaviors
Knowledge and/or experience with population health
Experience in two or more of the following: home health care, utilization review, discharge planning, Case and Disease management
Experience working with Managed Care products, benefits and services
Experience in planning, implementing coordinating and monitoring activities that focus on acute and non-acute services, outpatient services and/or community resources for all lines of business
Non-traditional working hours (limited) on occasion to meet the member's availability
Intermediate to Advanced experience in MS Word, Excel, tablet and/or smartphone
Travel up to 20% (subject to change) for on-site member/provider/employer meetings, events, or manager requests with occasional overnight stays

What is preferred:
Bachelor's degree in a related field
CCM, CCTC, CCTN
Bilingual English/Spanish

General Physical Demands:
Sedentary work: Exerting up to 10 pounds of force occasionally to move objects. Jobs are sedentary if traversing activities are required only occasionally.

We are an Equal Opportunity/Protected Veteran/Disabled Employer committed to creating a diverse, inclusive, and equitable culture for our employees and communities.