HSS Clin Coordinator RN - Telecommute in Florida

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This position will be the primary care manager for a panel of members with primary complex medical needs. The Care Management / coordination activities will focus on supporting member's medical, behavioral and socioeconomic needs to promote appropriate utilization of services and improved quality of care. All case management/ coordination activities will be in alignment with evidence-based guidelines. This position will liaison with the members' provider community to help reduce fragmentation within the care ecosystem.

The role will provide medically oriented clinical consults/guidance within the team and to other area within the health plan. The Clinical Care Manager will approach their member work with an understanding of how inequities drive health disparities. They will promote health equity

Working

Schedule:

Schedule is Monday through Friday between the hours of 8 am to 5 pm. This position is a field-based position with a home-based office. You will work from home when not in the field.

This position is primarily telephonic however if there is a need for a member visit, the visit will be scheduled closest to RN's zip code. These are the following counties Alachua, Bradford, Citrus, Columbia, Dixie, Gilchrist, Hamilton, Hernando, Lafayette, Lake, Levy, Marion, Putnam, Sumter, Suwannee, Union, Hardee, Highlands, Hillsborough, Manatee, Polk, Miami-Dade and Monroe

Local travel up to 15% and mileage is reimbursed at current government rate.

• Serve as primary care manager for members with primary complex medical needs
• Engage members through a variety of modalities (face and/or telephonically) to complete a comprehensive needs assessment, including assessment of medical, behavioral, functional, cultural, socioeconomic and SDOH needs
• Develop and implement person centered care plans to address needs including management of chronic health conditions, health promotion and wellness, social determinants of health, medication management and member safety in alignment with evidence-based guidelines
• Partner and collaborate with internal care team, providers, community resources/partners and leverage expertise to implement care plan
• Monitor and update care plan, incorporating feedback from member to monitor compliance with interventions to achieve care plan goals
• Provide education and coaching to support:
• Member self-management of care needs in alignment with evidence-based guidelines
• Lifestyle changes to promote health, i.e. smoking cessation, weight management, exercise
• Assist member in development of personal wellness plan / health crisis plan
• Perform targeted activities and provide education to support HEDIS/STAR gap closure, including scheduling, reminding and verification of appointment to receive specific services
  Monitor compliance with medication regimen and make referrals to Pharmacist for medication review and recommendations
• Reassess and update care plan with change in condition or care needs
• Support proactive discharge planning and manage/coordinate Care Transition following ER visit, inpatient or Skilled Nursing Facility (SNF) admission
• Access and Coordinate Medicaid Benefits to support care needs
• Document all care management/coordination activity in clinical care management record

You'll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in.

• Current, unrestricted, independent licensure as a Registered Nurse
• 4+ years of relevant clinical work experience
• 3+ years of experience managing needs of complex populations (eg. Medicare, Medicaid)
• 1+ years of community case management experience coordinating care for individuals with complex needs
• Demonstrated knowledge of Medicare and Medicaid benefits
• Ability to travel 15% of time for role
• Access to a designated quiet workspace in your home (separated from non-workspace areas) with the ability to secure Protected…