Nurse Case Manager II

Job 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.

Duties:

• 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.

Education:

• Associate Degree Required and BSN preferred.

Licensure:

• Active, unrestricted and good standing RN license in the state of Florida.

Experience:

• Specify the level of experience required mid-level.
• Managed Care experience.
• Discharge coordination experience.
• Transition of care experience.
• Home Health experience.
• Case Management experience.
• Minimum 2 years of clinical experience.

Skills & Abilities:

• Position requires proficiency with computer skills which includes navigating multiple systems.
• Ability to work in a fast-paced environment.
• Bi-Lingual Spanish/ English required.
• Applies critical thinking, evidence-based clinical criteria to support contractual rebalancing goals.

Additional Requirements:

• Candidate must reside in Miami-Dade County and will service Miami-Dade Co. and the Florida Keys and be able to travel to facilities within the regions/neighboring counties.
• Willing and able to travel 75% of their time to meet members face to face and surrounding counties/areas.