Title: Care Manager (RN)
Location:Region 11
Miami Dade; Monroe
(Member Facing Face to face visits 80% work from home /Travel is based on caseload (30%))
Duration: 3 Months (Potential to Extend/Convert)
Shift:
Monday - Friday 8-5 EST (not flexible)
Must haves: Pediatric experience of 2 years minimum
Nice to haves: Case Management experience
"Position Purpose:
- Develops, assesses, and facilitates complex care management activities for primarily physical needs members to provide high quality, cost-effective healthcare outcomes including personalized care plans and education for members and their families.
- Education/Experience:
- Requires a Degree from an Accredited School of Nursing or a bachelor's degree in nursing and 2 - 4 years of related experience.
- License/Certification:
- RN - Registered Nurse - State Licensure and/or Compact State Licensure required" "Evaluates the needs of the member, barriers to accessing the appropriate care, social determinants of health needs, focusing on what the member identifies as priority and recommends and/or facilitates the plan for the best outcome
- Develops ongoing care plans / service plans and collaborates with providers to identify providers, specialists, and/or community resources to address member's unmet needs
- Identifies problems/barriers to care and provide appropriate care management interventions
- Coordinates 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
- Provides ongoing follow up and monitoring of 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
- Provides resource support to members and care managers for local resources for various services (e.g., employment, housing, participant direction, independent living, justice, foster care) based on service assessment and plans, as appropriate
- Facilitate care management and collaborate with appropriate providers or specialists to ensure member has timely access to needed care or services
- May perform telephonic, digital, home and/or other site outreach to assess member needs and collaborate with resources
- 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
- Provides feedback to leadership on opportunities to improve and enhance care and quality delivery for members in a cost-effective manner
- Other duties or responsibilities as assigned by people leader to meet business needs
- Performs other duties as assigned
Complies with all policies and standards"
Member visits will not be hands on - assisting with case management needs but in person
No nursing will be conducted on the members
| Candidate Requirements |
| 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 |
| |
Must haves:
- 2+ years of social work experience or licensed mental health counselor in an acute
- care or community setting.
- Experience connecting families/children to local resources for various services including employment, housing, independent living, justice, foster care, etc.
- Behavioral Health Experience
- Strong communication
- Time management
- Critical thinking
- Computer literacy and Microsoft office (excel) filtering, - moderate level
Nice to haves:
- Health plan experience
- Foster care and/or adoption experience
- Bi-Lingual
- Knowledge of government sponsored managed care programs preferred.
- Psych background as long as the license is there with it
- BA Case Management as a RN
Previous job titles or background will work in this role? (MUST BE LICENSED)
- Dependency Case Manager
- Child Protective Investigator
- Adoption Case Manager
- Targeted Case Manager
- Community Agency Worker
Disqualifiers:
- Not meeting the 2+ years of peds experience
- Not being an RN
Performance indicators:
- Individuals will be audited monthly to ensure charts are in compliance.
- KPI metrics (are they meeting their monthly/quarterly outreach/ completing care plans, completion of annual assessments)
|
- Top 3 must-have hard skills
- Level of experience with each
- Stack-ranked by importance
- Candidate Review & Selection
|
1 |
Pediatric experience (2 years) - would love case management but not required precisely |
| 2 |
Bi-Lingual |
| 3 |
Behavioral Health Experience (training, certification, etc.) |
|
|
Spectraforce Technologies
remote work
Apr 10, 2025