Care Manager (RN)

Summary:

• Location: Buckeye Community Health Plan

Responsibilities:

• Evaluate the needs of the member, identify barriers to accessing appropriate care, and focus on member-identified priorities to recommend and facilitate the best outcomes.
• Develop ongoing care plans and collaborate with providers to identify specialists and community resources to address unmet needs.
• Identify problems/barriers to care and provide appropriate care management interventions.
• Coordinate between the member, family/caregivers, and care provider team to ensure adequate and appropriate person-centered care.
• Provide ongoing follow-up and monitoring of member status, condition changes, and progress toward care plan goals. Collaborate with members, caregivers, and providers to revise care plans as necessary.
• Provide resource support to members and care managers for local services based on assessment and plans.
• Facilitate care management and collaborate with providers or specialists to ensure timely access to needed care or services.
• Perform telephonic, digital, home, and site outreach to assess member needs and collaborate with resources.
• Collect, document, and maintain all member information and care management activities to ensure compliance with regulations.
• Provide education to members and their families/caregivers on disease processes, care gaps, provider instructions, care options, referrals, and benefits.
• Provide feedback to leadership on opportunities to improve care and quality delivery for members cost-effectively.
• Comply with all policies and standards.

Requirements:

• Degree from an Accredited School of Nursing or a Bachelor's degree in Nursing.
• Minimum 2 years of related experience.
• RN - Registered Nurse - State Licensure and/or Compact State Licensure required.

Preferred Skills:

• Experience in pediatric care for employees supporting Florida's Children’s Medical Services (CMS).
• Ability to travel locally up to 80% for Sunshine Health (FL) only.