Chronic Care Manager; RN) Onsite

• Location nd Avenue North,Clearwater, FL, 33760,United States
• Employee Type Exempt

• Name Sally Jackson

The Chronic Care 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 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

• A Minimum of three (3) years of recent adult clinical is required.
• A bachelor’s degree in nursing is strongly preferred.
• Previous work experience with a Medicare program is preferred.
• Bilingual (Spanish) is preferred.

• Certified Case Management (CCM) Certification is preferred.
• Current RN licensure in states where business is conducted.

Demonstrated computer proficiency with Microsoft Office, electronic health record (EHR/EMR) systems, Medicaid documentation and care management platforms, and the ability to efficiently navigate multiple electronic systems while maintaining accurate, timely, and compliant clinical documentation in accordance with state and regulatory requirements.

Work is performed in an office environment. While performing the duties of this job, the employee is regularly required to have the ability to maintain active customer and employee communication; access, input and retrieve information from the computer system; enter alpha-numeric data into a computerized system often while listening on the telephone.

May be subject to repetitive motion such as typing, data entry and sustained visual attention to monitors. The position requires prolonged periods of sitting, keyboarding, and viewing computer monitors. May be subject to bending, reaching, kneeling, stooping and lifting up to thirty (30) pounds.

Due to the nature of this position and its involvement with the Medicare members, you will have access to Protected Health Information (PHI) governed by the Health Insurance Portability and Accountability Act (HIPAA) and other applicable federal and state privacy laws.

This role has direct access to Protected Health Information (PHI). The following rules are non-negotiable:

• Absolute confidentiality:
  Employees must not disclose PHI to unauthorized individuals under any circumstances.
• Secure environment: A private, locked workspace must be maintained to prevent exposure of PHI to family members, visitors, or others.
• Company-approved technology only:
  All work must be performed on secure, company-issued devices using encrypted connections (VPN required).

You will be required to complete HIPAA training upon hire and annually thereafter. Any breach of confidentiality or unauthorized disclosure of patient information may result in disciplinary action up to and including termination and may carry legal consequences under state or federal law.