Nurse Case Manager

Location Requirement: Candidate must reside in the Tampa area and will service Hillsborough, Highlands, Polk, Hardee, and Manatee Counties, with the ability to travel to facilities within the assigned and neighboring regions.
Travel: Up to 75% local travel required.
Schedule: Monday Friday, 8:00 AM 5:00 PM EST (with some flexibility for start/stop times).

The Case Manager utilizes a collaborative process of assessment, planning, facilitation, and advocacy for services to meet an individual s benefit plan and/or health needs. Through effective communication and resource coordination, the Case Manager supports optimal, cost-effective outcomes, promotes successful transitions, and contributes to member satisfaction and retention.

• Apply critical thinking and evidence-based clinical criteria to support contractual rebalancing goals.

• Complete at least 10 Nursing Facility (NF) member assessments weekly.

• Support the Health Plan Rebalancing Initiative by assessing, identifying, screening, and transitioning NF members into the community.

• Follow up on Case Management referrals; visit current NF members in-person at least twice per week to complete rebalancing events and screening assessments.

• Conduct telephonic or in-person pre-discharge home assessments to identify environmental support needs (e.g., ramps, DME installation).

• Perform in-person Significant Change Visits within 5 days of transition; coordinate services, establish Plan of Care, and document all actions.

• Contact facility Business Offices weekly to follow up on member census; collaborate with Social Services and Case Managers to facilitate discharges.

• Partner with Case Managers to identify high-risk community members and implement interventions to support safe transitions and prevent lapses.

• Drive enhanced healthcare value to improve member satisfaction, retention, and new membership growth.

• Participate in at least two community relations events annually.