Nurse Case Manager II

Candidate must reside in Tampa area and will service Hillsborough, Highlands, Polk, Hardee, and Manatee Co and be able to travel to facilities within the regions/neighboring counties. Hours required are M - F 8am - 5 pm EST with some flexibility for start/ stop times. Local travel up to 75%. Applies critical thinking, evidence-based clinical criteria to support contractual rebalancing goals.

Complete at least 10 NF member assessments weekly

Support the Health Plan Rebalancing Initiative goal of successful transitions: Assess, identify, screen and transition NH members into the community

Follow up on CM referrals and visit current NH members in-person at least twice a week to complete the rebalancing events and screening assessments.

Complete telephonic or in-person contact to assess the home prior to discharge and identify any environmental supports needed to support transition (i.e. ramp, DME installation etc.).

Conduct an in-person Significant Change Visit with member and Rep if applicable, within 5 days of transition. Coordinate provision of services as needed, establish Plan of Care, and document all actions taken.

Contact facility s Business Office once a week to follow-up on mbr s census and will coordinate with Social Services and CM to facilitate discharge.

Work collaboratively with case managers to identify high risk community members and implement appropriate interventions to prevent lapse or coordinate safe transition (Upon receiving referral)

Drive enhanced value of health care to increase member satisfaction and retention, and drive new membership growth.

Be involved in at least two community relations event per year

Engage in building strong relationships that contribute towards member satisfaction and retention



Position Summary:



The Case Manager utilizes a collaborative process of assessment, planning, facilitation and advocacy for options and services to meet an individual s benefit plan and/or health needs through communication and available resources to promote optimal, cost-effective outcomes.



Requires an RN with unrestricted active license



Duties:



see decription



Experience:



Experience Needed: Candidate must reside in FL and area of coverage.- Minimum 2 years of clinical experience- Bi-Lingual Spanish/ English required.-Willing and able to travel 75% of their time to meet members face to face _______ and surrounding counties/areas.



Preferred Skills: Managed Care experience-Discharge coordination experience-Transition of care experience-Home Health experience- Case Management experience-- Position requires proficiency with computer skills which includes navigating multiple systems- Ability to work in a fast-paced environment

Experience Level: Specify the level of experience required mid-level



Education:



Education/Licensure: Active, unrestricted and good standing RN license in the state of Florida. Education: Associate Degree Required and BSN preferred.