Case Manager Inpatient and Outpatient setting (RN/LPN or Social Worker)

MAXhealth•Sarasota, FL

3d•Hybrid

About The Position

Multi-Specialty Medical group is seeking a strong candidate, responsible for ensuring the continuity of care in both the inpatient and outpatient setting. Responsible for utilizing the appropriate resources within the parameters of contracts and patients' health plan benefits. Facilitates continuum of patients' care utilizing nursing knowledge, experience and skills to ensure appropriate utilization of resources while ensuring high quality outcomes. Performs care management functions on-site or telephonically as the need arises. Reports findings to the Director of Care Management in a timely manner. Position can be fully remote/hybrid, but candidates must reside in the state of FL, GA, KY, NC, NV, PA, SC, TN, TX, VA, WI and PR. Candidate must be able to visit the clinics as needed. Bilingual is preferred but not required. Compensation Based on Experience and Qualifications. Typical work hours are Monday - Friday 8:00am to 5:00 pm with some flexibility.

Requirements

LPN or RN with current, unrestricted license in the state of Florida or Bachelors in Social Work
Three years in a professional setting such as hospital, clinic setting, or Managed Care Organization
Excellent organizational, time management, and prioritization skills
Critical thinking skills, excellent problem solving, and good decision making abilities
Demonstrate a professional appearance and demeanor with patients, providers and coworkers.
Proficiency with computers, experience in basic office programs and EMR or EHR systems.

Nice To Haves

Experience related to case management, utilization management, quality assurance, discharge planning or other cost management program
Experience working with Medicare Advantage Population
Bilingual

Responsibilities

Implement processes for assigned panel of identified patients who would benefit from case and disease management.
Assist patients to achieve highest level of wellness through timely and coordinated care management across the continuum of care.
Comprehensively assess patients for gaps in care and collaborate with treating physicians to develop care plans that meet patient's needs.
Collaborate with primary care providers to develop action plans to reduce unplanned utilization of resources.
Assure patients receive the right care, at the right level of care, and in the right setting, while working to reduce avoidable and unplanned utilization of resources.
Provide patient coaching, anticipatory guidance, advocacy, and condition specific education.
Communicate best practices to affiliated providers and their personnel to help facilitate effective clinical care and operational efficiency.
Enhance patient quality of care through reduction of avoidable admissions and emergency room utilization, and increase care to an optimal level with primary care providers and appropriate specialists.