[Hiring] RN Case Manager @Florida Blue

Role Description

The RN Case Manager primary responsibility is to create, implement, and monitor treatment plans to assist patients/members in meeting their healthcare goals. You would use knowledge of healthcare and social services to assess needs and provide interdisciplinary care options in treatment planning for the member.

• Case Management process includes assessing the member’s health status and care coordination needs.
• Contact with patient, family, physicians, additional health care providers, and community resources.
• Identification of alternative treatment plans, which would have to be approved by all parties.
• Assessment of the clinical status and resultant sequela to coordinate the most appropriate service to meet the individual’s health care needs.
• Identification of services, resources, providers, and facilities that could best serve members in a timely and cost-effective manner.
• Development and implementation of Case Management goals, both short and long term, with documented care plans.
• Utilize technology/resources to evaluate the cost-effectiveness of the elected treatment plan.
• Accurate and timely reporting as deemed appropriate by each client member.
• Medical record review to determine medical necessity of requested services.
• Interpreting individual health plans and authorizing/coordinating care in accordance with plan provisions.

Qualifications

• 5+ years related work experience with a professional background in clinical nursing and patient assessment.
• Related Bachelor’s degree or additional related equivalent work experience.
• Graduate of an accredited school of nursing.
• RN - Registered Nurse - State Licensure.
• Compact State Licensure in good standing.
• Knowledgeable in medical terminology, reasonable and necessary treatment plans, delivery quality health care services and cost containment practices.
• Ability to collaborate with cross-operational areas within the organization.

Requirements

• (CCM) Certified Case Manager preferred.
• Prior experience in utilization management or case management preferred, preferably within the managed care environment.
• Intensive care or higher-acuity patient experience preferred.
• Knowledge of managed care in a self-funded employer population is preferred.
• Ability to identify problems such as underutilization or overutilization of services.
• Ability to promote and maintain quality care through analysis.

Benefits

• Medical, dental, vision, life and global travel health insurance.
• Income protection benefits: life insurance, Short- and long-term disability programs.
• Leave programs to support personal circumstances.
• Retirement Savings Plan includes employer contribution and employer match.
• Paid time off, volunteer time off, and 11 holidays.
• Additional voluntary benefits available and a comprehensive wellness program.

General Physical Demands

Sedentary work: Exerting up to 10 pounds of force occasionally to move objects. Jobs are sedentary if traversing activities are required only occasionally.