Nurse Case Manager II

Description:
Candidates can reside anywhere in eastern timezone although they must have a license to practice in Florida.
Need screen shot of unrestricted and active license on top of the resume
List city and state of residence at top of resume
Must have a quite place with no distractions to work at home
The Care ManagerRegistered Nurse is a key member of our Special Needs Plan (SNP) care team, responsible for coordinating care for members who often face multiple chronic medical and behavioral health conditions, as well as various social determinants of health (SDoH) needs. This role involves conducting comprehensive assessments to evaluate members needs and addressing SDoH challenges by connecting them with appropriate resources and support services. The Social Worker provides education and guidance to members and their families on managing chronic conditions and navigating the healthcare system. Additionally, the Care Manager develops and implements individualized care plans, monitors member progress, advocates for necessary services, and collaborates with the interdisciplinary care team to ensure optimal health outcomes. Accurate and timely documentation of assessments and interventions is essential, as is participation in team meetings to discuss member status and care strategies.

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.

Education:
Add the minimum level of required completed education and certifications required
Associates of Science in Nursing (ASN) degree and relevant experience in a health care-related field (REQUIRED)
Bachelors of Science in Nursing (BSN) (PREFERRED)

Required Qualifications:
Only include the minimum measurable skills and years of experience that can be evaluated on a resume 
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%2B years of nursing experience
2%2B years of case management, discharge planning and/or home healthcare coordination experience

Preferred Qualifications:
Include non-measurable or soft skills that would be desirable, but not required; you can also provide additional context in this section
Experience providing care management for Medicare and/or Medicaid members
Experience working with individuals with SDoH needs, chronic medical conditions, and/or behavioral health
Experience conducting health-related assessments and facilitating the care planning process
Bilingual skills, especially English-Spanish

Duties:
Key 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 members 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 members care.
Provides care coordination to support a seamless health care experience for the member.
Meticulous documentation of care management activity in the members electronic health record.
Collaborate with other participants of the Interdisciplinary Care Team to address barriers to care and develop strategies for maintaining the members 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.

Experience:
Required Qualifications:
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%2B years of nursing experience
2%2B 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 SDoH needs, chronic medical conditions, and/or behavioral health
Experience conducting health-related assessments and facilitating the care planning process
Bilingual skills, especially English-Spanish

Position Summary:
The Care ManagerRegistered Nurse is a key member of our Special Needs Plan (SNP) care team, responsible for coordinating care for members who often face multiple chronic medical and behavioral health conditions, as well as various social determinants of health (SDoH) needs. This role involves conducting comprehensive assessments to evaluate members needs and addressing SDoH challenges by connecting them with appropriate resources and support services. The Social Worker provides education and guidance to members and their families on managing chronic conditions and navigating the healthcare system. Additionally, the Care Manager develops and implements individualized care plans, monitors member progress, advocates for necessary services, and collaborates with the interdisciplinary care team to ensure optimal health outcomes. Accurate and timely documentation of assessments and interventions is essential, as is participation in team meetings to discuss member status and care strategies.

Education:
Must have an unrestricted and active RN license

What days & hours will the person work in this position List training hours, if different.
Monday-Fri 8:00 am - 5