Case Management Nurse

Solis-Health-Plans; Florida; On-site; USD 63,000 - 77,000; Full time

Job summary

Solis Health Plans is seeking a Case Management Nurse (RN) to support members with complex medical needs and navigate the healthcare system. The role is fully onsite in Miami, FL, Monday through Friday, with a comprehensive benefits package starting on the first of the month after hire.

Qualifications include an active Florida RN license, 3 years of clinical RN experience, and certification in case management or care coordination.

Qualifications

• Nursing degree from an accredited program; active Florida RN license required.
• 3 years of RN clinical experience preferred.
• Certification in care coordination/Case Management preferred.
• Strong interpersonal and communication skills for interacting with patients, families, and care teams.
• Knowledge of evidence-based clinical guidelines and quality improvement methods.

Responsibilities

• Assess patients with complex needs across physical, psychological, social, and environmental domains.
• Develop individualized care plans aligned with patient goals and guidelines.
• Coordinate care across hospitals, primary and specialty clinics, and home care.
• Educate patients on self-management, medications, and preventive care.
• Participate in quality improvement initiatives and evaluate care effectiveness.
• Document assessments, plans, and outcomes in electronic health records.
• Collaborate with physicians, social workers, pharmacists, and other care managers.
• Support utilization management to ensure appropriate services and reimbursement.

Skills

Interpersonal skills

Communication skills

Critical thinking

Problem-solving

Decision-making

Education

Nursing degree

Florida RN license

Case management certification

Job description

If you are unable to complete this application due to a disability, contact this employer to ask for an accommodation or an alternative application process.

Case Management Nurse

Full Time Doral, FL, US

4 days ago Requisition ID: 1532

Salary: $70,000.00 Annually

About us: Solis Health Plans is a new kind of Medicare Advantage Company. We provide solutions that are more transparent, connected, and effective for both our members and providers. Solis was born out of a desire to provide a more personal experience throughout all levels of the healthcare journey. Our team consists of expert individuals that take pride in delivering quality service. We believe in a culture that collaborates and supports one another, and where success is interlinked, and each employee is valued. Please check out our company website at www.solishealthplans.com to learn more about us!

POSITION IS FULLY ONSITE Monday-Friday.

Location: 9250 NW 36th St, Miami, FL 33178.

English and Spanish are required

Full benefits package offered on the first of the month following date of hire including: Medical, Dental, Vision 401k plan with a 100% company match!

Our company has doubled in size, and we have experienced exponential growth in membership from 15,000 members to over 20,000 members in the last year!

Join our winning Solis Team!

Position Summary:

Solis Health Plans is looking for a Case Management Nurse (RN) who works for a health plan, assisting patients with complex medical needs to navigate the healthcare system and access appropriate care. The Case Management Nurse is responsible for coordinating and integrating care across different providers and settings, including hospitals, primary care offices, specialty clinics, and home care agencies.

Essential Duties and Responsibilities:

• Conducts comprehensive assessments of patients with complex medical needs to identify their physical, psychological, social, and environmental needs.
• Develops individualized care plans that address the patient's health goals, preferences, and priorities, and aligns with evidence-based clinical guidelines and best practices.
• Coordinates care across the healthcare continuum, including transitions of care between different settings and providers, and communicates with the patient, family, caregivers, and healthcare team members to ensure continuity and quality of care.
• Provides patient education on self-management of chronic conditions, medication management, preventive care, and healthcare navigation.
• Participates in quality improvement initiatives, evaluates the effectiveness of the care.
• Coordination and integration program and implements changes to improve outcomes and patient satisfaction.
• Maintains accurate and timely documentation of patient assessments, care plans, interventions, and outcomes, using electronic health record systems.
• Engages in ongoing professional development activities, such as continuing education, certification, and participation in professional organizations, tomaintain and enhance. knowledge and skills related to care coordination and integration.
• Collaborates with other members of the healthcare team, such as physicians, social workers, pharmacists, and case managers, to ensure that patients receive coordinated and integrated care that meets their needs and preferences.
• Works closely with the health plan's utilization management team to ensure that services are authorized and reimbursed appropriately.

Qualifications and Education:

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

• Nursing Degree from an accredited nursing program and be licensed as a registered nurse (RN) in the state of Florida. A clear and active license is required.
• 3 years of clinical experienceas an RN is preferred.
• Certification in care coordinationand transition management, Certified in CaseManagement (Preferred).
• Strong interpersonal and communication skillsto effectively interact with patients,families, and healthcare team members.They must also have strong critical thinking,problem-solving, and decision-making skillsto assess patient needs, develop care plans,and coordinate care across different settings and providers.
• Knowledge of evidence-based clinical guidelines, care coordination and integrationmodels, healthcare systems and policies, and quality improvement methods.

What set us apart:

Join Solis Health Plans as a Case Management Nurse and become a catalyst for positive change in the lives of our members. At Solis, you will be part of a locally rooted organization deeply committed to understanding and serving our communities. If you are eager to embark on a purpose-driven career that promises growth and the chance to make a significant impact, we encourage you to explore the opportunities available at Solis Health Plans. Join us and be the difference!