Nurse Case Manager II

Our Client, a Retail Pharmacy company, is looking for a Nurse Case Manager II - Florida for their Remote location.

Responsibilities:

• 50-75% of the day is dedicated to telephonic engagement with members and the coordination of their care.
• Compiles all available clinical information and partners with the member to develop an individualized care plan that encompasses goals and interventions to meet the member's identified needs.
• Provides evidence-based disease management education and support to help the member achieve health goals.
• Ensure the appropriate members of the interdisciplinary care team are involved in the member's care.
• Provides care coordination to support a seamless health care experience for the member.
• Meticulous documentation of care management activity in the member's electronic health record.
• Collaborate with other participants of the Interdisciplinary Care Team to address barriers to care and develop strategies for maintaining the member's stable health condition.
• Identifies and connects members with health plan benefits and community resources.
• Meets regulatory requirements within specified timelines.
• The Care Manager RN supports other members of the Care Team through clinical decision making and guidance as needed.
• Additional responsibilities as assigned by leadership to support team objectives, enhance operational efficiency, and ensure the delivery of high-quality care to members. This may include participating in special projects, contributing to process improvement initiatives, or assisting with mentoring new team members.
• Essential Competencies and Functions:
• Ability to meet performance and productivity metrics, including call volume, successful member engagement, and state/federal regulatory requirements of this role.
• Conduct oneself with integrity, professionalism, and self-direction.
• Experience or a willingness to thoroughly learn the role of care management within Medicare and Medicaid managed care.
• Familiarity with community resources and services.
• Ability to navigate and utilize various healthcare technology tools to enhance member care, streamline workflows, and maintain accurate records.
• Maintain strong collaborative and professional relationships with members and colleagues.
• Communicate effectively, both verbally and in writing.
• Excellent customer service and engagement skills.
• Work Expectations
• Access to a private, dedicated space to conduct work effectively to meet the requirements of the position
• Dependents must have separate care arrangements during work hours, as continuous care responsibilities during shift times are not permitted.

Requirements:

• Candidate must have active and unrestricted Compact Registered Nurse (RN) licensure in the state of residence
• Proficient in Microsoft Office Suite, including Word, Excel, Outlook, OneNote, and Teams, with the ability to effectively utilize these tools within the context of the Care Manager - Registered Nurse (CM RN) role
• Access to a private, dedicated space to conduct work effectively to meet the requirements of the position
• Dependents must have separate care arrangements during work hours, as continuous care responsibilities during shift times are not permitted.
• Confidence working at home / independent thinker, using tools to collaborate and connect with teams virtually
• 3+ years of nursing experience
• 2+ years of case management, discharge planning and/or home healthcare coordination experience
• Preferred Qualifications:
• Experience providing care management for Medicare and/or Medicaid members
• Experience working with individuals with needs, chronic medical conditions, and/or behavioral health
• Experience conducting health-related assessments and facilitating the care planning process
• Bilingual skills, especially English-Spanish
• Education:
• Add the minimum level of required completed education and certifications required
• Associate's of Science in Nursing (ASN) degree and relevant experience in a health care-related field (required)
• Bachelor's of Science in Nursing (BSN) (preferred)
• Verifyable High School Diploma or GED Required: Yes

Why Should You Apply?

• Health Benefits
• Referral Program
• Excellent growth and advancement opportunities