Managed Care Case Manager, RN - Remote
About The Position
This key position is responsible for assisting members within a geographical (local, statewide and/or other) area make effective health care choices for self-management of their acute and /or chronic condition(s). Utilizing a member-centric approach they assist members and their families understand and manage their disease process by: reinforcing the physicians' plan of treatment, promoting healthy behaviors and lifestyle changes, 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, digital engagement or electronically through email and member and provider portals.
Requirements
- RN - Registered Nurse - Active and Unrestricted State Licensure And/Or Compact State Licensure
- 2+ years related work experience. Experience Details: Communicating and building relationships with members/providers/employers both telephonically as well as live
- Related Bachelor’s degree or additional related equivalent work experience
- 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, disease/ case 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 to meet the member's availability
- Basic to intermediate experience in MS Word, Excel, tablet and/or smartphone
- Basic technology skills with digital tools and apps.
- Travel up to 30% (subject to change) for on-site member/provider/employer meetings, events or manager requests with occasional overnight stays
- Must have valid driver's license and reliable transportation
Nice To Haves
- Bachelor’s degree in a related field
- CCM - Certified Case Manager
- Bilingual English/Spanish and/or Creole
- Direct clinical experience (3-5 years)
- Experience working remotely (i.e. home office)
Responsibilities
- Engage Members telephonically, using digital engagement tools and/or face to face at Florida Blue Retail Centers, hospitals, etc. 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.
- Plan, implement, coordinate and monitor Case Management activities that may include acute and non-acute services, behavioral health and / or community resources.
- Facilitate care for 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.
- Close gaps in care
- Conduct Medication Reconciliation
- Collaborate with Member, Member’s Physicians, Plan Medical Directors, Managers, Local, Regional and Specialty team members as well as other functional areas to assist the member to meet their health care goals.
- Promote healthy lifestyles, assist in strengthening the patient-physician relationship, encourage behavior and lifestyle changes to realize a better quality of life, for individuals with identified chronic conditions, costly and/or catastrophic illnesses.
- Assist Members and their physicians to navigate through the health continuum, educate regarding benefits, identify candidates for Care Programs and provide information pertaining to the network and network access.
Benefits
- Medical, dental, vision, life and global travel health insurance
- Income protection benefits: life insurance, short- and long-term disability programs
- Leave programs to support personal circumstances
- Retirement Savings Plan including employer match
- Paid time off, volunteer time off, 10 holidays and 2 well-being days
- Additional voluntary benefits available
- A comprehensive wellness program
- competitive pay
- opportunities for incentive or commission compensation
- regular annual reviews with pay for performance considerations for base pay increases
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
Education Level
Associate degree
