Clinical – Care Manager (RN) Care Manager (RN) Position Available In [Unknown county], Florida

Clinical

• Care Manager (RN) Care Manager (RN)#25-58323
  Various, FL
  All On-site Job Description

Job Description:

Position Purpose:

Develops, assesses, and facilitates complex care management activities for primarily physical needs members to provide high quality, cost-effective healthcare outcomes including personalized care plans and education for members and their families.

Education/Experience:

Requires a Degree from an Accredited School of Nursing or a Bachelor’s degree in Nursing and 2

• 4 years of related experience.

License/Certification:

RN

• Registered Nurse
• State Licensure and/or Compact State Licensure requiredEvaluates the needs of the member, barriers to accessing the appropriate care, social determinants of health needs, focusing on what the member identifies as priority and recommends and/or facilitates the plan for the best outcome Develops ongoing care plans / service plans and collaborates with providers to identify providers, specialists, and/or community resources to address member’s unmet needs Identifies problems/barriers to care and provide appropriate care management interventions Coordinates as appropriate between the member and/or family/caregivers and the care provider team to ensure members are receiving adequate and appropriate person-centered care or services Provides ongoing follow up and monitoring of member status, change in condition, and progress towards care plan / service plan goals; collaborate with member, caregivers, and appropriate providers to revise or update care plan / service plan as necessary to meet the member’s goals / unmet needs Provides resource support to members and care managers for local resources for various services (e.

g., employment, housing, participant direction, independent living, justice, foster care) based on service assessment and plans, as appropriate Facilitate care management and collaborate with appropriate providers or specialists to ensure member has timely access to needed care or services May perform telephonic, digital, home and/or other site outreach to assess member needs and collaborate with resources Collects, documents, and maintains all member information and care management activities to ensure compliance with current state, federal, and third-party payer regulators Provides and/or facilitates education to members and their families/caregivers on disease processes, resolving care gaps, healthcare provider instructions, care options, referrals, and healthcare benefits Provides feedback to leadership on opportunities to improve and enhance care and quality delivery for members in a cost-effective manner Other duties or responsibilities as assigned by people leader to meet business needs
Performs other duties as assigned Complies with all policies and standards
Comments for

Vendors:

EEO:

“Mindlance is an Equal Opportunity Employer and does not discriminate in employment on the basis of

• Minority/Gender/Disability/Religion/LGBTQI/Age/Veterans.

” ========
Centene Job Description
Develops, assesses, and facilitates complex care management activities for primarily physical needs members to provide high quality, cost-effective healthcare outcomes including personalized care plans and education for members and their families.

Education/Experience:

Requires a Degree from an Accredited School of Nursing or a Bachelor’s degree in Nursing and 2

• 4 years of related experience.

License/Certification:

RN

• Registered Nurse
• State Licensure and/or Compact State Licensure requiredEvaluates the needs of the member, barriers to accessing the appropriate care, social determinants of health needs, focusing on what the member identifies as priority and recommends and/or facilitates the plan for the best outcome Develops ongoing care plans / service plans and collaborates with providers to identify providers, specialists, and/or community resources to address member’s unmet needs Identifies problems/barriers to care and provide appropriate care management interventions Coordinates as appropriate between the member and/or family/caregivers and the care provider team to ensure members are receiving adequate and appropriate person-centered care or services Provides ongoing follow up and monitoring of member status, change in condition, and progress towards care plan / service plan goals; collaborate with member, caregivers, and appropriate providers to revise or update care plan / service plan as necessary to meet the member’s goals / unmet needs Provides resource support to members and care managers for local resources for various services (e.

g., employment, housing, participant direction, independent living, justice, foster care) based on service assessment and plans, as appropriate Facilitate care management and collaborate with appropriate providers or specialists to ensure member has timely access to needed care or services May perform telephonic, digital, home and/or other site outreach to assess member needs and collaborate with resources Collects, documents, and maintains all member information and care management activities to ensure compliance with current state, federal, and third-party payer regulators Provides and/or facilitates education to members and their families/caregivers on disease processes, resolving care gaps, healthcare provider instructions, care options, referrals, and healthcare benefits Provides feedback to leadership on opportunities to improve and enhance care and quality delivery for members in a cost-effective manner Other duties or responsibilities as assigned by people leader to meet business needs
Performs other duties as assigned Complies with all policies and standards Story Behind the Need What is the purpose of this team?
Describe the surrounding team (team culture, work environment, etc.) & key projects. To facilitate with ScriptMed cloud ( a new Operating System) training and implementation.
Remote role that is mostly on the phone
Typical Day in the Role Walk me through the day-to-day responsibilities and a description of the project (Outside of the Workday JD).
What are the performance expectations/metrics?
What makes this role unique? Managed assigned worklist as well as pended worklist to make patient outreach providing clinical intervention.

• Take inbound and make outbound calls.
• Work collaboratively with other departments and the physician’s office to ensure best patient outcomes.
• Manage emails, messages, and trainings daily.
• Participate in trainings and meetings as needed.
  Specialty pharmacy experience
  Must be able to manage daily tasks with a high quality of work.
• Goals will be given to the candidate to help them work towards the department’s expectations for success.

Candidate Requirements
Education/Certification

Required:

Associate’s degree in nursing

Preferred:

Licensure

Required:

Current State’s RN license

Preferred:

Years of experience required: 2+ years of clinical nursing experience in a clinical, acute care, or community setting and 1+ years of case management experience in a managed care setting. Knowledge of utilization management principles and healthcare managed care. Experience with medical decision support tools (i.e. Interqual, NCCN) and government sponsored managed care programs. Top 3 must-have hard skills stack-ranked by importance 1 2+ years of clinical nursing experience in a clinical, acute care, or community setting and 1+ years of case management experience in a managed care setting.
2 Knowledge of utilization management principles and healthcare managed care.
3 Candidate Review & Selection Shortlisting process
Candidate review & selection
Interview information
Onboard process and expectations

Projected Manager Candidate Review Date:

1-2 days post shortlisting

Type of Interviews:

Teams,
Required Testing or Assessment (by Vendor): NA Steps Additional background check requirements (List DFPS or other specialty checks here) Do you have any upcoming PTO? Colleagues to cc/delegate Rene Crespo Are there any training requirements (time off, alternate schedule, etc.)?