Perform care management duties to assess, plan and coordinate all aspects of medical and supporting services across the continuum of care for select members to promote quality, cost effective care.
Walk me through the day-to-day responsibilities of this the role and a description of the project (Outside of Workday JD):
Outreaching member to enroll them in CM program
Building care plans, medication review, assessments care plans
Describe the performance expectations/metrics for this individual and their team:
20 calls/day
Tell Me About What Their First Day Looks Like
System-specific training
Responsibilities
Develop, assess and adjust, as necessary, the care plan and promote desired outcome.
Assess the member's current health status, resource utilization, past and present treatment plan and services, prognosis, short- and long-term goals, treatment and provider options
Coordinate services between Primary Care Physician (PCP), specialists, medical providers, and non-medical staff as necessary to meet the complete medical socio-economic needs of clients
Develop plan of care based upon assessment with specific objectives, goals and interventions designed to meet member's needs
Provide patient and provider education
Facilitate member access to community-based services
Monitor referrals made to community-based organizations, medical care and other services to support the members’ overall care management plan
Actively participate in integrated team care management rounds
Identify related risk management quality concerns and report these scenarios to the appropriate resources
Enter and maintain assessments, authorizations, and pertinent clinical information into various medical management systems
Education/Experience
Graduate from an Accredited School of Nursing. Bachelor’s degree in Nursing preferred.
2+ years of pediatric clinical nursing experience in a clinical, acute care, or community setting. Knowledge of healthcare and managed care preferred.
Florida residency required. Knowledge of healthcare and managed care preferred.
Prior experience working in a remote role preferred.
Prior case management experience preferred.
Bilingual in Spanish and English is preferred.
Licenses/Certifications
Current state’s RN license and CA RN License.
Seniority level
Mid-Senior level
Employment type
Contract
Job function
Health Care Provider
Industries
Staffing and Recruiting
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