Nurse Case Manager II

Put candidates City, State and Zip Code and County at top of resume.
Candidates MUST be Central Fl, Must reside in Orange, Osceola, Brevard or Seminole counties
-Bilingual REQUIRED (Spanish, English) FLUENT speaking and writing.
-Ability to multitask, prioritize and effectively adapt to a fast-paced changing environment.
-Effective communication skills, both verbal and written.
-Candidate will travel approximately 85% of the time within Orange, Osceola, Brevard or Seminole counties visiting members at their homes, in Assisted Living Facilities and Skilled Nursing Facilities.
***Must be fluent in English & Spanish and be able to have a full conversation***
This is not a nursing role, do not submit nurse candidates.
Candidates can submit mileage. Safety sensitive (field and telephonic)
Schedule is Monday - Friday, 8:00AM - 5:00PM, Standard Business Hours. Candidate must abide to these hours.
We are seeking self-motivated, energetic, detail oriented, highly organized, tech-savvy Case Management Coordinator to join our Case Management team. Our organization promotes autonomy through a Monday - Friday (8:00AM - 5:00PM) working schedule and flexibility as you coordinate the care of your members. Case Management Coordinator is responsible for telephonically and/or face to face assessing, planning, implementing, and coordinating all case management activities with members to evaluate the medical needs of the member to facilitate the members overall wellness. Case Management Coordinator will effectively manage a caseload that includes supportive and medically complex members. Develops a proactive course of action to address issues presented to enhance the short and long-term outcomes as well as opportunities to enhance a members overall wellness through integration. Case Management Coordinators will determine appropriate services and supports due to members health needs; including but not limited to: Prior Authorizations, Coordination with PCP and skilled providers, Condition management information, Medication review, Community resources and supports.

Position Summary:


-Candidates must reside in MUST be Central Fl, Must reside in Orange, Osceola, Brevard or Seminole counties
-Bilingual REQUIRED (Spanish, English) FLUENT speaking and writing.
-Ability to multitask, prioritize and effectively adapt to a fast-paced changing environment.
-Effective communication skills, both verbal and written.
-Candidate will travel approximately 85% of the time within Miami-Dade County visiting members at their homes, in Assisted Living Facilities and Skilled Nursing Facilities.The Case Manager utilizes a collaborative process of assessment, planning, facilitation and advocacy for options and services to meet an individuals benefit plan and/or health needs through communication and available resources to promote optimal, cost-effective outcomes.

RN with current unrestricted state licensure in FL or Valid COMPACT License.
Case Management Certification CCM preferred

Duties:

Coordinates case management activities for Medicaid Long Term Care/Comprehensive Program enrollees. Utilizes critical thinking and judgment to collaborate and inform the case management process, in order to facilitate appropriate healthcare outcomes for members by providing care coordination, support and education for members through the use of care management tools and resources. Conducts comprehensive evaluation of Members using care management tools and information/data review. Coordinates and implements assigned care plan activities and monitors care plan progress. Conducts multidisciplinary review to achieve optimal outcomes. Identifies and escalates quality of care issues through established channels. Utilizes negotiation skills to secure appropriate options and services necessary to meet the members benefits and/or healthcare needs. Utilizes influencing/ motivational interviewing skills to ensure maximum member engagement and promote lifestyle/behavior changes to achieve optimum level of health. Provides coaching, information and support to empower the member to make ongoing independent medical and/or healthy lifestyle choices. Helps member actively and knowledgeably participate with their provider in healthcare decision-making. Monitoring, Evaluation and Documentation of Care: Utilizes case management and quality management processes in compliance with regulatory and accreditation guidelines and company policies and procedures.

Experience:

3 years Clinical practice experience, e.g., hospital setting, alternative care setting such as home health or ambulatory care required.
Healthcare and/or managed care industry experience.
Case Management experience preferred-- Position requires proficiency with computer skills which includes navigating multiple systems and keyboarding
Effective communication skills, both verbal and written.
Ability to multitask, prioritize and effectively adapt to a fast paced changing environment
Sedentary work involving periods of sitting, talking, listening. Work requires sitting for extended periods, talking on the telephone and typing on the computer.
Work requires the ability to perform close inspection of hand written and computer generated documents as well as a PC monitor.
Typical office working environment with productivity and quality expectations?

Education:

RN with current unrestricted state licensure in FL or Valid COMPACT License.
Case Management Certification CCM preferred