Case Manager (RN)

Under the general supervision of the Manager of Case Management, the RN Case Manage is responsible for the ongoing assessment, planning, and evaluation of members within the care management program.  The incumbent acts as a liaison between patient/family and healthcare personnel to ensure that the necessary care is provided promptly and effectively.

ESSENTIAL DUTIES AND RESPONSIBILITIES

1. Oversees clinical, non‐clinical and administrative staff.
2. Is responsible for MOC activities, including HRA, individualized care plan, interdisciplinary care team and care transitions.
3. Manages D‐SNP members, in particular those belonging to the most vulnerable population.
4. Identifies needs and create a care plan, with the input of the member’s interdisciplinary care team, to help the member achieve their goals.
5. Completes assessments with member/caregiver/provider to obtain information regarding client status, functional, cognitive capabilities, support system and need for services.
6. Supports ongoing member engagement.
7. Addresses the member’s individual needs, strengths, preferences, and goals.
8. Educates members on their conditions and promote self‐management skills including the understanding signs and symptoms that indicate a need to contact the PCP, and when it is appropriate to seek urgent or emergent care.
9. Supports medication adherence.
10. Engages in member‐centric discharge planning.
11. Ensures timely initiation of post‐discharge services and care.

QUALIFICATIONS

• Knowledge of Dual Eligible Special Needs Plans, Centers for Medicare and Medicaid Services (CMS), and Florida Medicaid.
• Understanding of Case Management best practices.
• Understanding of medical necessity for appropriate patient status and level of care.
• Strong verbal and electronic communication skills.

WORK EXPERIENCE

• Minimum of two (2) years of experience in Care/Case Management.
• Medicare and/or Medicaid managed care experience

CERTIFICATES, LICENSES, REGISTRATIONS

Valid and current license as a Registered Nurse in the state of Florida