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Medicare Readmission Prevention RN-Tampa - Case Management at Blue Cross Blue Shield of Florida

Medicare Readmission Prevention RN-Tampa - Case Management

Blue Cross Blue Shield of Florida Fort Lauderdale, FL (Onsite) Full-Time

Medicare Readmission Prevention RN-Tampa

What We Can Offer YOU!

We offer competitive salaries and benefits, work-life balance, flexible work arrangements, opportunities for growth and development, and a great place to work across our enterprise!

What Will Be Your Purpose:

Under the direction of the Readmission Prevention Manager, the Readmission Prevention RN will provide support to Florida Blue Medicare members who are at risk for readmission. FBM's Readmission Prevention team will outreach members during and post hospitalization, to assist them in overcoming major "barriers to care". This activity is done through a variety of methods such as home, facility or office visits, telephonic support and follow-up. The goal is to improve the health outcomes of these at risk members and reduce FBM's overall readmission rates.

What Will You Be Doing:

* Meeting with members, (and/or their caregivers) who are at high risk for readmission, post discharge, in person, if at all possible, if not by phone, within 2 business days of discharge.
* Performing assessments of members current health status, including potential knowledge deficits, environment, care giver(s) and others supports, creating a care plan identifying problems, goals and interventions, based on member's responses, conditions, needs and priorities, as appropriate.
* Conduct Comprehensive Medication Reconciliation process, including education, identification of potential medication concerns, document and address any possible issues with the ordering physician, pharmacy, etc. and provide CMR report to PCP
* Validate the initiation of planned care and services, reinforce understanding of discharge instructions utilizing teach back methods, answer questions as appropriate and address concerns.
* Coordinate/assign necessary interventions including any available community resources, enhanced benefits or flex benefit to overcome potential barriers to care, e.g. meals, transportation, etc.
* Facilitate appropriate practitioner office follow-up visit within 7-14 days of discharge. Follow-up with member and practitioner to confirm appointment was kept. (5%)
* Provide continuing telephonic support/follow up for at least 30 days post facility discharge.

What You Must Have:

* 2 years related work experience. Experience Details: Recent clinical and/or case experience
* Required Management Experience

No supervisory/management experience required
* Required Education

High school diploma or GED
* Required Licenses and Certifications

RN - Registered Nurse - State Licensure And/Or Compact State Licensure Without Restriction Upon Hire
* CCM - Certified Case Manager 1 1/2 Yrs
* Current and valid state driver's license and current liability insurance coverage

What We Prefer:

* Bachelor's degree Nursing
* CCM - Certified Case Manager Upon Hire
* Home care Experience
* Bilingual English/Spanish

General Physical Demands:

Sedentary work: Exerting up to 10 pounds of force occasionally to move objects. Jobs are sedentary if traversing activities are required only occasionally.

Physical/Environmental Activities

Must be able to travel to multiple locations for work (i.e. travel to attend meetings, events, conferences).

We are an Equal Opportunity/Protected Veteran/Disabled Employer committed to creating a diverse, inclusive and equitable culture for our employees and communities.

Recommended Skills

  • Assessments
  • Case Management
  • Certified Nurse Practitioner
  • Clinical Works
  • Deficits
  • English
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