CCM; RN) Hybrid​/Remote Case Manager

• Location Remote - Clearwater, FL, United States
• Job Category CHS CCM Clw.
• Employee Type Exempt

• Name Sally Jackson

The Case Manager is a Registered Nurse who provides case management, education and outreach services telephonically to Medicare members in the Chronic Case Management Program. This position requires licensure as a Registered Nurse in the State of Florida, compact licensure required. This is a hybrid / remote position.

• Fulfills requirements established by Community Health Solutions to complete monthly contacts with enrolled members. Ensuring the information contained in the system of record is accurate and complete.
• Provides members with education required to achieve optimal health maintenance and arranges appropriate education services, if necessary.
• Collaborate with the Care Advocate Team to ensure all required services, communications, documentation, and ancillary needs are addressed. Maintains availability to members and providers to coordinate any required services.
• Serve as a member advocate. Addresses and identifies complaints, grievances, or concerns and escalates to the appropriate stakeholder(s), when necessary.
• Identifies availability of advanced directives, needs for ancillary services, specialty services and community services.
• Upon member ineligibility or other circumstance in which disenrollment from the program becomes necessary, complete all needed activities to ensure continuation of care and communicate with all stakeholders to ensure an uninterrupted transition of care.
• Serve as a mandated reporter.
• Will have access and manage PHI in accordance with federal and state requirements (HIPAA, HITECH).

LPN oversight

• Strong organizational, interpersonal and motivational skills
• Excellent written and verbal communication skills
• Detail oriented
• High level of reasoning and analytical skills
• Ability to multi-task and work independently

• Licensure as a Registered Nurse in the State of Florida.
• A compact license is required, or provide documents that you are in the process.
• A Minimum of three (3) years of recent adult clinical experience is required.
• A bachelor’s degree in nursing is strongly preferred.

• Previous work experience with a Medicare program is preferred.
• Certified Case Management (CCM) Certification is preferred.
• Bilingual (Spanish) is preferred.

• Demonstrated computer proficiency with Microsoft 365 products, electronic health record (EHR/EMR) systems, clinical data entry, telehealth platforms, Medicare documentation processes, and the ability to learn and navigate facility-specific software applications.
• Proficiency using software programs such as Microsoft Word, PowerPoint, Excel, Outlook, and Adob e

This position is primarily performed from a remote home office. The employee is responsible for maintaining a professional, safe, and secure home workspace with reliable high-speed internet access that supports the secure handling of confidential and protected health information (PHI).

While performing the essential functions of this position, the employee will regularly use a computer, telephone, and other office equipment; communicate with patients, caregivers, providers, and team members through various electronic platforms; and enter, retrieve, and maintain information in multiple electronic health record (EHR) and Medicaid documentation systems. The position requires prolonged periods of sitting, keyboarding, and viewing computer monitors.

The position may require standing, walking, bending, reaching, kneeling, stooping, and lifting or carrying materials and equipment weighing…