Care Manager I

Duties And Responsibilities

• Conduct assessments to identify individual needs and a specific care management plan to address objectives and goals identified during assessment(s) for patients enrolled in Care/Disease Management.
• Evaluate Fall Risk PHQ-9, Health literacy, and risk of unplanned admission.
• Carefully coordinate pre-admission discharge and schedule admission.
• Afford assistance in identifying high-risk populations (i.e., high utilizers, multiple co-morbidities, polypharmacy, non-compliance, at risk for readmission, oxygen dependent, bed and wheelchair bound, etc...).
• Maintain oversight of the Homebound population and assist with home lab and home visit coordination.
• Afford assistance in managing medical urgencies, not limited to assisting with IVs, wound care, medication administration, etc.
• Communicate with patient’s provider, health plan care manager, and pharmacy team member as needed to assist in coordination of care.
• Provide education to the patient about the Hotline (Urgency Team), health plan benefits, CCMC services, and community resources.
• Assess the patient for physical functional limitations, poor social support system, and behavioral health needs.
• Afford assistance in problem-solving with providers, utilization or service issues, prior authorization requests, and long-term care applications.
• Ensure patient knowledge of medication compliance and reduce the risk of polypharmacy by providing education and support to help them better understand how to use their medication effectively.
• Implement activities to promote cost savings, such as: Potentially prevent admissions by coordinating outpatient care, Reduce readmissions (Target 10%), Improve Generic Dispensing Rate, Assist patients with coordinating care pertaining to HEDIS/Preventive health screenings. (Target 5 Stars in all Part C and Part D measures, 4 stars in Readmissions)

Qualifications / Education / Licenses

• Associate degree in nursing required.
• Active Registered Nurse license in Florida.
• Two years of acute clinical experience required.
• Two years of care or case management experience in hospital, health plan, or clinic setting required.
• Proficient computer skills, including experience with Microsoft Excel, Word, and Outlook.
• Strong written and verbal communication skills.
• Excellent clinical assessment and analytical skills.
• Bilingual in English and Spanish preferred.