Nurse Case Manager

City/State

Gainesville, FL

Overview

Work Shift

First (Days) (United States of America)

AvMed, a division of Sentara Health Plans in the Florida market, is hiring a Nurse Case Manager in Miami or Gainesville, Florida. This is a hybrid position, 2 days in office and 3 days remote.

Scope of the Position: The Nurse Case Manager coordinates, directs, and oversees all aspects of care for members, including program cost saving analysis, quality assurance and improvement, claims and contracting issues, statistical outcomes, and resolution of any related concern. Serves as the primary liaison between high-risk members, physicians, health care providers, and community resources. Coordinates continuity of care initiatives that favorably impact the quality of Member's health, ensures effective use of healthcare resources, and promotes member satisfaction.

Essential Job Functions:

• Uses current and innovative case management practices to identify and develop solutions that meet member's or caregiver's needs, proactively anticipates barriers to goals and ensures all activities are completed timely and documented thoroughly to meet regulatory requirements.

• Conducts comprehensive, holistic assessments of member health, medical and psychosocial needs; assesses member benefits and access to community organizations; develops an individualized care plan to ensure member needs and outcomes are met; prepares documentation.

• Develops strategic care plans with the member and/or caregiver to promote adherence and collaboration and achieve favorable outcomes.

• Develops and maintains a communication schedule to evaluate member's progress to goals and facilitate coordination of care.

• Serves as liaison between various providers and the member and/or caregiver to promote effective working relationships.

• Performs additional duties and responsibilities as assigned by management.

Minimum Requirements:

• Registered Nurse with an active and unrestricted FL license

• Associate degree

• Demonstrates the minimum knowledge, skills, and abilities to care for the individualized needs of the patient to include physical, psychological, socio-cultural, spiritual, and cognitive needs as well as functional abilities including the need for diversified use of such practices.

• Requires strong oral, written, and interpersonal communication skills, prob lem-solving skills, facilitation skills, and analytical

• 3 years of nursing experience

• 2 years of managed care

• Previous discharge planning

Preferred Requirements:

• Bachelor's in nursing

• Two years of care/case management, discharge planning, clinical review or utilization management experience

• Certified Case Manager (CCM)

Our Benefits:

As the third-largest employer in Virginia, Sentara Health was named by Forbes Magazine as one of America's best large employers. We offer a variety of amenities to our employees, including, but not limited to:

• Medical, Dental, and Vision Insurance

• Paid Annual Leave, Sick Leave

• Flexible Spending Account

• Retirement funds with matching contribution

• Supplemental insurance policies, including legal, Life Insurance and AD&D among others

• Work Perks program including discounted movie and theme park tickets among other great deals

• Opportunities for further advancement within our organization

Sentara employees strive to make our communities healthier places to live. We're setting the standard for medical excellence within a vibrant, creative, and highly productive workplace. For information about our employee benefits, please visit: Benefits

• Sentara (sentaracareers.com)

Join our team! We are committed to quality healthcare, improving health every day, and provide the opportunity for training, development, and growth!

Note: Sentara Healthcare offers employees comprehensive health care and retirement benefits designed with you and your family's well-being in mind. Our benefits packages are designed to change with you by meeting your needs now and anticipating what comes next. You have a variety of options for medical, dental and vision insurance, life insurance, disability, and voluntary benefits as well as Paid Time Off in the form of sick time, vacation time and paid parental leave. Team Members have the opportunity to earn an annual flat amount Bonus payment if established system and employee eligibility criteria is met.

Keywords: Talroo-health Plan, #Indeed, Health Plan, Manage Care, Acute, Home Healthcare, Discharge Planning

Job Summary

RN Clinician responsible for case management services within the scope of licensure; develops, monitors, evaluates, and revises the member's care plan to meet the member's needs, with the goal of optimizing member health care across the care continuum. Performs telephonic or face-to-face clinical assessments for the identification, evaluation, coordination and management of member's needs, including physical and behavioral health, social services and long-term services. Identifies members for high-risk complications and coordinates care in conjunction with the member and health care team. Manages chronic illnesses, co-morbidities, and/or disabilities ensuring cost effective and efficient utilization of health benefits; conducts gap in care management for quality programs. Assists with the implementation of member care plans by facilitating authorizations/referrals within benefits structure or extra-contractual arrangements, as permissible. Interfaces with Medical Directors, Physician Advisors and/or Inter-Disciplinary Teams on care management treatment plans. Presents cases at case conferences for multidisciplinary focus. Ensures compliance with regulatory, accrediting and company policies and procedures. May assist in problem solving with provider, claims or service issues.

Requires an RN; BSN preferred

Demonstrates the minimum knowledge, skills and abilities to care for the individualized needs of the patient to include physical, psychological, socio-cultural, spiritual and cognitive needs as well as functional abilities including the need for diversified use of such practices. Requires strong oral, written and interpersonal communication skills, problem-solving skills, facilitation skills, and analytical skills.

Qualifications:

ALD - Associate's Level Degree: Nursing (Required), BLD - Bachelor's Level Degree, BLD - Bachelor's Level Degree: Nursing (Required)

Registered Nurse (RN) Single State

• Nursing License

• Florida, Registered Nurse (RN) Single State

• Nursing License

• North Carolina, Registered Nurse (RN) Single State

• Nursing License

• Virginia

Discharge Planning, Managed Care, Nursing

Skills

Communication, Complex Problem Solving, Critical Thinking, Judgment and Decision Making, Microsoft Office, Service Orientation

Sentara Healthcare prides itself on the diversity and inclusiveness of its close to an almost 30,000-member workforce. Diversity, inclusion, and belonging is a guiding principle of the organization to ensure its workforce reflects the communities it serves.

Per Clinical Laboratory Improvement Amendments (CLIA), some clinical environments require proof of education; these regulations are posted at ecfr.gov for further information. In an effort to expedite this verification requirement, we encourage you to upload your diploma or transcript at time of application.

In support of our mission "to improve health every day," this is a tobacco-free environment.