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    Clinical - Care Manager I (RN) - Tampa, United States - Axelon

    Axelon
    Axelon Tampa, United States

    2 weeks ago

    Default job background
    Description

    Job Description:
    Description - External

    Position Purpose:

    Perform care management duties to assess, plan and coordinate all aspects of medical and supporting services across the continuum of care for select members to promote quality, cost effective care Remote, compact state needed with NY licensure.

    Potential to extend x 1

    The new hire would not need to live in NY but we they do need a NY license as this is our primary market.

    Along with that NY primary market we also serve a secondary market of transplant members from other states.

    No need for the new hire to worry about how to manage transplant members, my team can train on the differences on case managing transplant if/when needed.


    • Develop, assess and adjust, as necessary, the care plan and promote desired outcome
    • Assess the member's current health status, resource utilization, past and present treatment plan and services, prognosis, short and long term goals, treatment and provider options
    • Coordinate services between Primary Care Physician (PCP), specialists, medical providers, and non-medical staff as necessary to meet the complete medical socio economic needs of clients
    • Develop plan of care based upon assessment with specific objectives, goals and interventions designed to meet member's needs
    • Provide patient and provider education
    • Facilitate member access to community based services
    • Monitor referrals made to community based organizations, medical care and other services to support the members' overall care management plan
    • Actively participate in integrated team care management rounds
    • Identify related risk management quality concerns and report these scenarios to the appropriate resources
    • Enter and maintain assessments, authorizations, and pertinent clinical information into various medical management systems
    Qualifications - External

    Education/Experience:
    Graduate from an Accredited School of Nursing. Bachelor's degree in Nursing preferred. 2+ years of pediatric clinical nursing experience in a clinical, acute care, or community setting. Knowledge of healthcare and managed care preferred. Florida residency required. Knowledge of healthcare and managed care preferred. Prior experience working in a remote role preferred. Prior case management experience preferred. Bilingual in Spanish and English is preferred.

    Licenses/Certifications:
    Current state's RN license.

    *Pediatrics - birth to 21

    *Work-from-home case management role Walk me through the day-to-day responsibilities of this the role and a description of the project : Remote telephonic case management, Care manager (CM) follows model of care to assist member in managing health care needs.

    Conducts initial assessments, medication review, develops care plan with member, identifies member needs and connects member with appropriate resources to meet health care needs.

    Interacts with members care team, community services, vendors.

    Follows up with member every 30 days at minimum to review conditions, progress toward goals, and ensure member is receiving requested information and/or services.

    Provides education on member health plan and coverage and management of identified health conditions.
    Describe the performance expectations/metrics for this individual and their team:

    CM caseload expectation is 75 actively managed members, Audit score of 90%or greater, Case duration 90 days.
    Tell me about what their first day looks like:


    First day is usually corporate HR training, Setting up company issued equipment and access necessary to perform role specific duties.

    What previous job titles or background work will in this role?

    RN, experience in case management preferred, clinical nursing background of 5 years or more.
    Any future projected positions potentially coming up? Choose an item


    If yes, note:
    Internal/External Groups with which the Candidate will interface: Required Skills/Experience: Preferred Skills/ Experience: 1. Registered Nurse, 5 plus years clinical RN experience 1. Medicare Case management experience 2. Compact License 2. CCM certification 3. 3.

    Education Requirement:
    Graduate of accredited RN program

    Education Preferred:
    RN, BSN

    Software Skills Required:
    Microsoft office products

    Required Certifications:

    CCM preferred Required Testing:
    #J-18808-Ljbffr
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