Case Manager RN

Must have active and unrestricted RN licensure in the state of Florida OR compact licensure in state of residence
3+ years of clinical experience
2+ years of case management, discharge planning and/or home healthcare coordination experience

Responsible for assessing, planning, implementing, and coordinating all case management activities with members to evaluate the medical needs of the member to facilitate the member’s overall wellness
Develops a proactive plan of care to address identified issues to enhance the short and long-term outcomes as well as opportunities to enhance a member’s overall wellness
Uses clinical tools and information/data review to conduct an evaluation of member’s needs and benefits
Applies clinical judgment to incorporate strategies designed to reduce risk factors and barriers and address complex health and social indicators which impact care planning
Conducts assessments that consider information from various sources, such as claims, to address all conditions including co-morbid and multiple diagnoses that impact functionality
Uses a holistic approach to assess the need for a referral to clinical resources and other interdisciplinary team members
Consults with supervisor and others in overcoming barriers in meeting goals and objectives, presents cases at interdisciplinary case conferences
Utilizes case management processes in compliance with regulatory and company policies and procedures
Utilizes motivational interviewing skills to ensure maximum member engagement and discern their health status and health needs based on key questions and conversation

Certified Case Manager
Excellent analytical and problem-solving skills
Bilingual
Effective communications, organizational, and interpersonal skills
Ability to work independently
Effective computer skills including navigating multiple systems and keyboarding
Proficiency with standard corporate software applications, including MS Word, Excel, Outlook, and PowerPoint, as well as some special proprietary applications