RN Case Manager

About the role

This role provides telephonic case management for Medicare Advantage members in Florida, focusing on comprehensive care coordination, clinical assessments, and ongoing support.

Responsibilities

• Perform telephonic case management for Medicare Advantage members residing in the state of Florida.
• Conduct comprehensive clinical assessments to identify members’ medical, functional, and psychosocial needs.
• Develop, implement, and update individualized care plans based on assessments, member goals, and clinical guidelines.
• Carefully coordinate care across various settings, including hospital, acute care, home health, and hospice, to ensure continuity of care.
• Manage new referrals by reviewing clinical information, initiating outreach, and determining appropriate case management interventions.
• Call members regularly to monitor health status, reinforce care plans, provide education, and address emerging needs or concerns.
• Build, maintain, and update member cases in the Athena EMR platform, ensuring accurate and timely documentation of all interactions and interventions.
• Maintain a caseload of at least 73 members, prioritizing tasks and managing time effectively to meet clinical and operational expectations.
• Utilize strong triage skills to identify urgent needs, escalate issues appropriately, and support safe, timely care decisions.
• Review and interpret medical records and clinical documentation to support care planning and utilization management activities.
• Collaborate with physicians, care teams, and community resources to coordinate services and support optimal patient outcomes.
• Apply managed care and utilization management principles to ensure appropriate use of healthcare resources.
• Deliver high-quality customer service to members and their families, addressing questions and concerns with professionalism and empathy.
• Use Microsoft Office tools, including Excel, for data entry, tracking, and reporting related to case management activities.
• Maintain thorough, accurate, and compliant documentation of all member interactions, assessments, and care coordination activities in the EMR.
• Work effectively in a fast-paced, high-acuity environment while maintaining attention to detail and clinical quality.
• Demonstrate a strong commitment to case management as a primary professional focus, contributing to a culture of patient-centered care.

Essential Skills

• Active Registered Nurse (RN) license in the state of Florida.
• At least 2 years of case management experience in hospital, acute care, home health, or hospice settings.
• Experience with Athena EMR software/platform for documentation and case management.
• Demonstrated case management and care management experience, including care coordination and care plan development.
• Background in managed care and utilization management within a healthcare setting.
• Strong computer skills, including proficiency with Microsoft Office Suite and Excel.
• Accurate and efficient data entry and electronic documentation skills.
• Prior experience in home health or hospice case management.
• Familiarity with patient care workflows across multiple care settings, including hospital and post-acute environments.
• Ability to work independently with minimal supervision while maintaining high standards of clinical practice.
• Strong organizational skills and attention to detail in managing multiple priorities and tasks.
• Comfort using various digital tools and systems to support remote or hybrid work.
• Interest in wellness, preventive care, and patient education as part of case management practice.

Additional Skills & Qualifications

• Experience in telephonic case management for Medicare or Medicare Advantage populations.
• Prior experience in home health or hospice case management.
• Familiarity with patient care workflows across multiple care settings, including hospital and post-acute environments.
• Ability to work independently with minimal supervision while maintaining high standards of clinical practice.
• Strong organizational skills and attention to detail in managing multiple priorities and tasks.
• Comfort using various digital tools and systems to support remote or hybrid work.
• Interest in wellness, preventive care, and patient education as part of case management practice.

Work Environment

This is a hybrid position that combines remote telephonic work with potential on-site or office-based activities, depending on business needs. The standard schedule is Monday through Friday, 8:00 a.m. to 5:00 p.m., providing a consistent daytime workweek. You will use the Athena EMR platform and Microsoft Office tools extensively, working in a technology-driven environment that emphasizes accurate electronic documentation and efficient virtual communication.

Benefits

• Comprehensive benefits package that includes multiple medical plan options (such as High Deductible Plans and PPO plans) with integrated prescription drug coverage, as well as dental and vision plans that cover preventive and routine services.
• Financial protection benefits including life and accidental death and dismemberment insurance, along with short-term and long-term disability coverage.
• A 401(k) retirement plan with company match supports long-term financial security.
• Additional programs include wellness initiatives and an Employee Assistance Program offering confidential counseling and support services.

About Actalent

Actalent is a global leader in engineering and sciences services and talent solutions. We help visionary companies advance their engineering and science initiatives through access to specialized experts who drive scale, innovation and speed to market. With a network of almost 20,000 consultants and 5,000 clients across the U.S., Canada, Asia and Europe, Actalent serves many of the Fortune 500. We are proud to be an Engineering News-Record (ENR) Top 500 Design Firm for our engineering design services and a ClearlyRated Best of Staffing® winner for both client and talent service. The company is an equal opportunity employer and will consider all applications without regard to race, sex, age, color, religion, national origin, veteran status, disability, sexual orientation, gender identity, genetic information or any characteristic protected by law. If you would like to request a reasonable accommodation, such as the modification or adjustment of the job application process or interviewing process due to a disability, please email actalentaccommodation@actalentservices.com for other accommodation options.