Job Code - Care Manager (RN)
Job Location: Remote Florida w/ member visits50% remote - 50% member facing
Job Duration: 3 Months
"Position Purpose:
Assesses, plans, and implements complex care management activities based on member activities to enable quality, cost-effective healthcare outcomes. Develops a personalized care plan / service plan for care members, addresses issues, and educates members and their families/care givers on services and benefit options available to receive appropriate high-quality care.
Education/Experience:
Requires a Degree from an Accredited School or Nursing or a Bachelor's degree in Nursing and 4 - 6 years of related experience.
License/Certification:
RN - Registered Nurse - State Licensure and/or Compact State Licensure required
For Illinois Youth Care Contract: Bachelor's degree in nursing required" "Develops and continuously assesses ongoing care plans / service plans and collaborates with providers to identify providers, specialist, and/or community resources needed to address member's unmet needs
Coordinates and manages as appropriate between the member and/or family/caregivers and the care provider team to ensure members are receiving adequate and appropriate person-centered care or services
Monitors care plans / service plans and/or member status, change in condition, and progress towards care plan / service plan goals; collaborate with member, caregivers, and appropriate providers to revise or update care plan / service plan as necessary to meet the member's goals / unmet needs
May identify problems/barriers for care management and appropriate care management interventions for escalated cases
Reviews member data to identify trends and improve operating performance and quality care in accordance with state and federal regulations
Reviews referrals information and intake assessments to develop appropriate care plans/service plans
May perform telephonic, digital, home and/or other site outreach to assess member needs and collaborate with resources
Collaborates with healthcare providers as appropriate to facilitate member services and/or treatments and determine a revised care plan for member if needed
Collects, documents, and maintains all member information and care management activities to ensure compliance with current state, federal, and third-party payer regulators
Provides and/or facilitates education to members and their families/caregivers on disease processes, resolving care gaps, healthcare provider instructions, care options, referrals, and healthcare benefits
Partners with leadership team to improve and enhance care and quality delivery for members in a cost-effective manner
May precept clinical new hires by fostering and building core skills, coaching and facilitating their growth, and guiding through the onboarding process to upskill readiness ?
Provides guidance and support to clinical new hires/preceptees in navigating within a Managed Care Organization (MCO) and provides coaching and shadowing opportunities to bridge gap between classroom training and field practice?
Engages and assists New Hire/Preceptee during onboarding journey including responsibility for completing competency check points ensuring readiness for Service Coordination success
Engages in a collaborative and ongoing process with People Leaders and cross functional teams to measure and monitor readiness
Other duties or responsibilities as assigned by people leader to meet business needs
Performs other duties as assigned
Complies with all policies and standards"
This is a position for medically fragile pediatric members that require a face to face visit once a month with a second contact required telephonically once a month. These members have PDN (Private Duty Nursing) in the home caring for the member's needs to assist the caregivers. Caseload size is max 40 members. The RN care manager for this role will be required to offer this face to face visit, and if the parent declines then a virtual face to face visit may be offered. These members also require an annual assessment that can be conducted over the phone during a telephonic outreach. If the parent is unable to reach then the RN CM will be required to call the private duty nursing agency to obtain an update on the member's health status for the month. A monthly assessment is entered into our charting system at the end of the month to reflect the member's health status, visits attended, and summary of nursing staffing in the home for the month. The RN care manager's role is to assist the parent/caregivers with any needs or questions related to the member's care in the community setting.
| Education/Certification |
Required: Requires a Degree from an Accredited School of Nursing or a Bachelor's degree in Nursing and 2 - 4 years of related experience. |
Preferred: n/a |
| Licensure |
Required: RN - Registered Nurse - State Licensure and/or Compact State Licensure required |
Preferred: n/a |
|
8-5 M-F, no OT. This is a remote position that will require an organized individual to schedule face to face meetings, schedule and obtain the required telephonic contact for updates, and to compile that information timely into ECC assessments at the end of the month. One hour lunch break and 2 breaks daily are awarded for employee. The employee will be sent a company cell phone, computer, headset, and an additional monitor for charting prior to their start date. There are multiple team chats utilized daily where CMs share resources and assist each other with questions. The new hire will have a preceptor and a supervisor to assist.
Offer face to face visit first and then if declined a virtual visit (pediatric care with nursing in home
Must haves: Pediatric experience of 2 years minimum
Nice to haves: Case Management experience
Disqualifiers: not meeting minimum requirements
- Top 3 must-have hard skills
- Level of experience with each
- Stack-ranked by importance
- Candidate Review & Selection
|
1 |
Strong organization and documenting skills |
| 2 |
Proficiency with computers, Teams, Microsoft Outlook, experience with excel |
| 3 |
Confidence to call parents and providers to resolve issues |
|
Position is offered by a no fee agency.
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Spectraforce Technologies
May 14, 2025