Case Management Nurse

Solis Health Plans• Doral, FL, US, FL

2d•Onsite

About The Position

Solis Health Plans is a new kind of Medicare Advantage Company. We provide solutions that are more transparent, connected, and effective for both our members and providers. Solis was born out of a desire to provide a more personal experience throughout all levels of the healthcare journey. Our team consists of expert individuals that take pride in delivering quality service. We believe in a culture that collaborates and supports one another, and where success is interlinked, and each employee is valued. Please check out our company website at www.solishealthplans.com to learn more about us! The position is fully onsite Monday-Friday. Location: 9250 NW 36th St, Miami, FL 33178. English and Spanish are required. Our company has doubled in size, and we have experienced exponential growth in membership from 15,000 members to over 20,000 members in the last year! Join our winning Solis Team!

Requirements

Nursing Degree from an accredited nursing program and be licensed as a registered nurse (RN) in the state of Florida. A clear and active license is required.
Strong interpersonal and communication skills to effectively interact with patients, families, and healthcare team members.
Strong critical thinking, problem-solving, and decision-making skills to assess patient needs, develop care plans, and coordinate care across different settings and providers.
Knowledge of evidence-based clinical guidelines, care coordination and integration models, healthcare systems and policies, and quality improvement methods.
English and Spanish are required.

Nice To Haves

3 years of clinical experience as an RN is preferred.
Certification in care coordination and transition management, Certified in Case Management (Preferred).

Responsibilities

Conducts comprehensive assessments of patients with complex medical needs to identify their physical, psychological, social, and environmental needs.
Develops individualized care plans that address the patient's health goals, preferences, and priorities, and aligns with evidence-based clinical guidelines and best practices.
Coordinates care across the healthcare continuum, including transitions of care between different settings and providers, and communicates with the patient, family, caregivers, and healthcare team members to ensure continuity and quality of care.
Provides patient education on self-management of chronic conditions, medication management, preventive care, and healthcare navigation.
Participates in quality improvement initiatives, evaluates the effectiveness of the care.
Coordination and integration program and implements changes to improve outcomes and patient satisfaction.
Maintains accurate and timely documentation of patient assessments, care plans, interventions, and outcomes, using electronic health record systems.
Engages in ongoing professional development activities, such as continuing education, certification, and participation in professional organizations, to maintain and enhance knowledge and skills related to care coordination and integration.
Collaborates with other members of the healthcare team, such as physicians, social workers, pharmacists, and case managers, to ensure that patients receive coordinated and integrated care that meets their needs and preferences.
Works closely with the health plan's utilization management team to ensure that services are authorized and reimbursed appropriately.