RN Case Manager

About the role

This key position is responsible for assisting members within a geographical area make effective health care choices for self-management of their acute and/or chronic condition(s).

Responsibilities

• Engage Members telephonically, using digital engagement tools and/or face to face at Florida Blue Retail Centers, hospitals, etc. with a focus on health coaching and member education.
• Facilitate access to care and resources to meet the member’s health care needs.
• Provide education and tools to promote self-management.
• Plan, implement, coordinate and monitor Case Management activities that may include acute and non-acute services, outpatient services, behavioral health and / or community resources.
• Facilitate care for high risk members across the continuum of the health care experience, including care transitions, coordination of community and social service and coordinating with other value-based organizations, providers as needed.
• Close gaps in care
• Conduct Medication Reconciliation
• Collaborate with Member, Member’s Physicians, Plan Medical Directors, Managers, Local, Regional and Specialty team members as well as other functional areas to assist the member to meet their health care goals.
• Promote healthy lifestyles, assist in strengthening the patient-physician relationship, encourage behavior and lifestyle changes to realize a better quality of life, for individuals with identified chronic conditions, costly and/or catastrophic illnesses.
• Aid Members and their physicians to navigate through the health continuum, educate regarding benefits, identify candidates for Care Programs and provide information pertaining to the network and network access.

Requirements

• 2+ years related work experience.
• Experience Details in communicating and building relationships with members/providers/employers both telephonically as well as live.
• Related Bachelor’s degree or additional related equivalent work experience.
• Registered Nurse - State Licensure and/or Compact State Licensure.
• Experience with influencing and motivating individuals to change health behaviors.
• Knowledge and/or experience with population health.
• Experience in two or more of the following: home health care, utilization review, discharge planning, disease/ case management.
• Experience working with Managed Care products, benefits and services.
• Experience in planning, implementing coordinating and monitoring activities that focus on acute and non-acute services, outpatient services and/or community resources for all lines of business.
• Basic to intermediate experience in MS Word, Excel, tablet and/or smartphone.
• Basic technology skills with digital tools and apps.
• Occasional travel up to 30% (subject to change) for on-site member/provider/employer meetings, events or manager requests with occasional overnight stays.
• Must have valid driver's license and reliable transportation.

Qualifications

• Bachelor’s degree in a related field.
• CCM - Certified Case Manager.
• Bilingual English/Spanish and/or Creole.
• Direct clinical experience (3-5 years).
• Experience working remotely (i.e. home office).
• Experience with utilization management and continuum of care planning.

Skills

• General Physical Demands.

Benefits

• Comprehensive benefits are offered.
• Income protection benefits: life insurance, short- and long-term disability programs.
• Leave programs to support personal circumstances.
• Retail Savings Plan including employer match.
• Paid time off, volunteer time off, 10 holidays and 2 well-being days.
• Additional voluntary benefits available; and a comprehensive wellness program.

Pay

Typical Annualized Offer/Hiring Range: $71,200 - $89,000 Annualized Salary Range: $71,200 - $115,700 Final pay will be determined with consideration of market competitiveness, internal equity, and the job-related knowledge, skills, training, and experience you bring.

Schedule

Non-traditional working hours to meet the member's availability.