Integrated Case Manager - Registered Nurse

About the role

The Integrated Case Manager, RN will provide case management services within the scope of licensure, focusing on optimizing member health care across the care continuum. Responsibilities include conducting telephonic clinical assessments, developing and managing care plans, coordinating care with providers, and presenting cases at case conferences.

Responsibilities

• Identify and evaluate member's needs, including physical and behavioral health, social services, and long-term services within the Disease Management program.
• Manage chronic illnesses, co-morbidities, and disabilities, ensuring cost-effective and efficient utilization of health benefits.
• Facilitate authorizations and referrals within the benefits structure or extra-contractual arrangements.
• Interface with Medical Directors, Physician Advisors, and Inter-Disciplinary Teams on care management treatment plans.
• Ensure compliance with regulatory, accrediting, and company policies and procedures.
• Assist in problem-solving with provider, claims, or service issues.

Requirements

• Registered Nurse (RN) license required.
• 3 years of nursing experience required.
• Bilingual in Spanish preferred.
• Experience in managed care and Disease Management preferred.

Qualifications

• Demonstrated knowledge, skills, and abilities to care for the individualized needs of patients, including physical, psychological, socio-cultural, spiritual, and cognitive needs, as well as functional abilities.
• Strong oral, written, and interpersonal communication skills.
• Problem-solving and facilitation skills.
• Analytical skills.

Skills

• Effective communication skills.
• Ability to manage multiple tasks and prioritize responsibilities.
• Knowledge of healthcare regulations and policies.
• Interdisciplinary collaboration skills.

Benefits

• Caregiver and parental leave.
• Paid time off and sick leave.
• Emergency backup care.
• Disability insurance.
• Retirement savings plans.
• Tuition assistance.
• Student debt repayment assistance.
• Professional development opportunities.
• Pet insurance.
• Legal resources.

Pay

Compensation is commensurate with experience.

Schedule

The position is remote but requires residency in Florida.