Case Manager, Value Based

Tampa Family Health Centers•Tampa, FL

2d•Remote

About The Position

The Value-Based Case Manager plays a critical role in advancing Tampa Family Health Centers’ value-based care strategy by improving clinical outcomes, reducing total cost of care, and supporting quality performance for Accountable Care Organizations (ACO) and managed care plans. This position focuses on proactive patient outreach, care coordination, and performance improvement aligned with HEDIS, STARS, and other quality adherence measures. The Value-Based Case Manager works collaboratively as part of the care team to implement evidence-based protocols for primary care patients.

Requirements

One to two (1–2) years of experience in care management, case management, or population health within a Primary Health Care organization and/or Managed Care non-clinical setting.
Graduate of an accredited School of Nursing.
Associate Degree in Nursing (ADN) required.
Current Florida license as a Registered Nurse (RN).

Nice To Haves

Bachelor of Science in Nursing (BSN) preferred.
Knowledge of case management principles, procedures, and practices.
Knowledge of clinical quality indicators, including but not limited to HEDIS, STARS, MIPS, Meaningful Use, and UDS.
Proficiency with Microsoft Office products, including Word, Excel, and PowerPoint, as well as Electronic Health Records (EHR).
Ability to communicate and present ideas effectively in both written and verbal formats.
Ability to conduct detailed analytical evaluations and studies and prepare related reports and recommendations.
Strong organizational, communication, care coordination, and patient-engagement skills.
Ability to collaborate effectively with clinical, administrative, managed care, and value-based care teams.

Responsibilities

Support strategies to reduce unnecessary healthcare utilization while ensuring high-quality, patient-centered care.
Track and analyze utilization patterns, care gaps, and outcomes for assigned patient populations.
Identify and prioritize patients who impact quality, utilization, and cost outcomes.
Complete chart preparation to facilitate completion of Value-Based Services priorities, including care gaps, referrals, and laboratory ordering.
Review electronic and hard-copy medical records and supporting documentation to abstract clinical data for value-based reporting.
Document findings in applicable value-based databases and prescribed cloud-based platforms.
Attend regular meetings with assigned carriers to review plan data and develop strategies to improve outcomes for patient cohorts.
Prepare and present value-based data reports to the Executive Vice President of Value Based Services.
Train and advise healthcare professionals and clinical and administrative staff regarding value-based compliance.
Establish patient follow-up schedules and monitor patient progress using electronic care management tracking systems within the Electronic Health Record (EHR).
Monitor ENS and hospital discharge reports to facilitate patients' connection with appropriate care.
Conduct inbound and outbound telephone outreach to patients identified as having high-risk, chronic, and complex care needs.
Meet with patients and/or supportive family members or responsible parties to assess current needs and barriers and establish patient-directed, measurable goals.
Utilize educational materials, brief intervention techniques, and community resources to engage patients, increase motivation for change, and assist patients in establishing and implementing behavior-change goals.
Perform other duties as assigned.