RN Care Manager HFHP - Clinical Integration Services

Position SUMMARY

To be fully engaged in providing Quality/No Harm, Customer Service and Stewardship by functioning as part of a multidisciplinary team in an outpatient setting. The RN Care Manager acts as a patient advocate, educator, and care coordinator for a specific patient population across the continuum of care.

Primary Accountabilities

• Perform reviews to assure members are receiving care in the appropriate setting at the appropriate level.
• Complete a thorough assessment that collects in-depth information about a member’s unique situation and functioning, including Social Risk Factors SDF, in order to identify individual needs. Information gathered should include direct client contact information and all other relevant sources. Based on identified needs, develop a comprehensive case management plan.
• Develop a care management plan in conjunction with the member and the rest of the member’s care team, including the PCP, specialist, and other members of the care team.
• Implement plans by executing and documenting specific interventions, activities and/or tasks that will lead to accomplishing the established goals.
• Provide health coaching on member/family self-management skills and navigation support for the member’s unique health conditions and needs.
• Document all member interactions, assessments, care plan updates, and coordination of care interventions designed to accomplish established goals per program requirements in the care management document system.
• Evaluate the plan at appropriate intervals to determine the effectiveness in reaching the goals and outcomes. Monitor the member’s compliance with the treatment plan and modify the plan as necessary.
• Maintain member confidentiality and privacy, ensuring member safety, adherence to advocacy ethics as well as legal and accreditation/regulatory standards.
• Provide education to patients, families, and significant others: act as an information resource to health care professionals, patients, and the public.
• Evaluate member’s appropriateness for referrals for other care management programs and/or community resources and services and assist with coordination of these services.
• Participate in performance improvement activities, data collection and continuous quality improvement (CQI) activities.

MINIMUM QUALIFICATIONS

• Education:
• AAS or above
• Graduation from an accredited School of Nursing
• Licensure: Current Florida RN license free of any restrictions or disciplinary action pending and able to legally and independently practice without the supervision of another licensed professional,
• Certification: None
• Work Experience: Three years clinical experience
• Work Experience in lieu of Education: N/A
• Knowledge/Skills/Abilities:
• Intermediate computer skills e.g. navigation and workflow within an EMR, or medical management applications, Microsoft Office Applications and the ability to document accurately.
• Ability to work autonomously with minimal supervision
• Strong attention to detail, quality of work, and critical thinking skills
• Strong communication skills and professional presence
• Ability to maintain composure in stressful office environment
• Ability to work shifts at various times of the day with additional on-call and weekend responsibilities.

PREFERRED QUALIFICATIONS

• Education: Bachelor’s degree in nursing
• Licensure: Compact State RN license
• Certification:
• Case Management Certification
• Lean Yellow Belt Certification
• Work Experience: Two years' experience in Utilization Management, Case Management, or Managed Care
• Knowledge/Skills/Abilities:
• Knowledge of Coordination of Benefits
• Knowledge of Reimbursement across the continuum of healthcare to propose alternative treatment options.
• Knowledge of alternative treatments options, alternative funding programs and community services and resources.
• Bilingual

PHYSICAL REQUIREMENTS

• Majority of time involves sitting or standing; occasional walking, bending, stooping.
• Long periods of computer time or at workstation.
• Light work that may include lifting or moving objects up to 20 pounds with or without assistance.
• May be exposed to inside environments with varied temperatures, air quality, lighting and/or low to moderate noise.
• Communicating with others to exchange information.
• Visual acuity and hand-eye coordination to perform tasks.
• Workspace may vary from open to confined, on site or remote.