Care Manager (RN)

Spectraforce Technologies; Miami (FL); Remote; USD 50,000 - 80,000; Full time

Job summary

An established industry player is seeking a dedicated Care Manager (RN) to join their innovative team in Miami. This role involves developing personalized care plans and facilitating complex care management activities for members, primarily focusing on physical needs. The position offers a blend of remote work and face-to-face interactions, ensuring that members receive the highest quality of care. Ideal candidates will have a strong background in nursing, excellent communication skills, and a passion for improving healthcare outcomes. If you're looking to make a meaningful impact in the lives of others, this opportunity is perfect for you.

Qualifications

• Requires RN licensure and 2-4 years of related experience.
• Experience in social work or mental health counseling preferred.

Responsibilities

• Perform care management duties to assess and coordinate medical services.
• Create assessments and care plans for members.
• Conduct outreach calls to check on members' needs.

Skills

Pediatric experience

Bi-Lingual

Behavioral Health Experience

Strong communication skills

Time management

Critical thinking skills

Computer literacy

Education

Degree from an Accredited School of Nursing

Bachelor's degree in nursing

Tools

Microsoft Office (Excel)

Job description

Title: Care Manager (RN)

Duration: 03 Months - Contract to Hire

Location: Remote FL (Member Facing) - Candidate must reside within region 11 - Miami Dade; Monroe

Member Facing Face to face visits 80% work from home /Travel is based on caseload (30%)

Leadership works to have the new hire work within a 50-mile radius - may vary based on caseload

Monday - Friday 8-5 EST

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.

Responsibilities:

1. 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.
2. Coordinate care (finding providers)
3. Assisting in authorization
4. Creating assessments and care plans
5. Complete daily outreach calls based on member-specific tiers
6. Call volume will vary 5-20 calls per day depending on members' needs
7. Contractual obligation is a weighted 200 caseload with Tier 3 at 2.2 and Tier 4 at 1
8. Outreach calls are to check in on members, follow up on their needs, and remove any barriers to care.
9. Ensure children's needs are met (issues at school, home health aides, etc.)
10. Leadership will perform chart and call audits monthly or as needed.
11. Documentation is key

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.

Candidate Requirements:

Education/Certification	Required: Degree from an Accredited School of Nursing or a bachelor's degree in nursing with 2 - 4 years of related experience. Preferred: n/a
Licensure	Required: RN - Registered Nurse - State Licensure and/or Compact State Licensure required

Additional Requirements:

• At least 2+ years of social work or licensed mental health counselor experience 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, and critical thinking skills
• Computer literacy and moderate proficiency in Microsoft Office (Excel)

Nice to Haves:

• Health plan experience
• Foster care and/or adoption experience
• Bi-Lingual capabilities
• Knowledge of government-sponsored managed care programs
• Psych background with license
• BA Case Management as an RN

Performance Indicators:

• Monthly chart audits for compliance
• Meeting KPIs on outreach, care plan completion, and assessments

Top 3 Hard Skills:

1. Pediatric experience (2 years)
2. Bi-Lingual
3. Behavioral Health Experience

Position is offered by a no fee agency.