CCM (RN) Hybrid/Remote Case Manager -Florida

City of Lincoln; Clearwater (FL); Hybrid; USD 65,000 - 90,000; Full time

Benefits offered by this job

Hybrid/Remote work

Job summary

Community Health Solutions is seeking a skilled Case Manager (RN) to provide telephonic case management, education and outreach to Medicare members in the Chronic Case Management Program. The position requires Florida RN licensure and a compact license, and is offered as a hybrid/remote role.

The ideal candidate will coordinate care with the Care Advocate Team, ensure accurate documentation in the EHR, maintain confidentiality per HIPAA, and support member advocacy and transition of care across

Qualifications

• Licensed Registered Nurse in Florida required.
• Compact license accepted or in process documentation.
• Minimum three years of adult clinical experience.
• Bachelor’s degree in nursing preferred.
• Experience with Medicare programs preferred.
• CCM certification and bilingual (Spanish) preferred.

Responsibilities

• Fulfills monthly contacts with enrolled members and maintains accurate records.
• Educates members to achieve optimal health and coordinates education services.
• Collaborates with Care Advocate Team to address services and documentation.
• Advocates for members and escalates concerns as needed.
• Identifies needs for directives, ancillary, specialty, and community services.
• Ensures seamless transition of care during disenrollment scenarios.
• Maintains HIPAA compliance and PHI security.
• Accesses and manages PHI per security policies.

Skills

Communication skills

Organizational skills

Multitasking

Analytical skills

Verbal communication

Motivational skills

Education

Florida RN license

Compact license acceptable

Bachelor's degree preferred

Tools

Microsoft 365

EHR/EMR systems

Telehealth platforms

Medicare documentation

Job description

• Location Remote - Clearwater, FL, United States


• Job Category CHS CCM Clw.


• Employee Type Exempt

Contact information

• Name Sally Jackson

Position Summary

The Case Manager is a Registered Nurse who provides case management, education and outreach services telephonically to Medicare members in the Chronic Case Management Program. This position requires licensure as a Registered Nurse in the State of Florida, compact licensure required. This is a hybrid / remote position.

Essential Duties and Responsibilities

• Fulfills requirements established by Community Health Solutions to complete monthly contacts with enrolled members. Ensuring the information contained in the system of record is accurate and complete.


• Provides members with education required to achieve optimal health maintenance and arranges appropriate education services, if necessary.


• Collaborate with the Care Advocate Team to ensure all required services, communications, documentation, and ancillary needs are addressed. Maintains availability to members and providers to coordinate any required services.


• Serve as a member advocate. Addresses and identifies complaints, grievances, or concerns and escalates to the appropriate stakeholder(s), when necessary.


• Identifies availability of advanced directives, needs for ancillary services, specialty services and community services.


• Upon member ineligibility or other circumstance in which disenrollment from the program becomes necessary, complete all needed activities to ensure continuation of care and communicate with all stakeholders to ensure an uninterrupted transition of care.


• Serve as a mandated reporter.


• Will have access and manage PHI in accordance with federal and state requirements (HIPAA, HITECH).

Supervisory Responsibilities

LPN oversight

• Strong organizational, interpersonal and motivational skills


• Excellent written and verbal communication skills


• Detail oriented


• High level of reasoning and analytical skills


• Ability to multi-task and work independently

Qualifications:

• Licensure as a Registered Nurse in the State of Florida.


• A compact license is required, or provide documents that you are in the process.


• A Minimum of three (3) years of recent adult clinical experience is required.


• A bachelor’s degree in nursing is strongly preferred.

Certificates, Licenses, Registrations:

• Previous work experience with a Medicare program is preferred.


• Certified Case Management (CCM) Certification is preferred.


• Bilingual (Spanish) is preferred.

Computer Skills:

• Demonstrated computer proficiency with Microsoft 365 products, electronic health record (EHR/EMR) systems, clinical data entry, telehealth platforms, Medicare documentation processes, and the ability to learn and navigate facility-specific software applications.


• Proficiency using software programs such as Microsoft Word, PowerPoint, Excel, Outlook, and Adob e

Environmental Factors/Physical Demands

This position is primarily performed from a remote home office. The employee is responsible for maintaining a professional, safe, and secure home workspace with reliable high-speed internet access that supports the secure handling of confidential and protected health information (PHI).

While performing the essential functions of this position, the employee will regularly use a computer, telephone, and other office equipment; communicate with patients, caregivers, providers, and team members through various electronic platforms; and enter, retrieve, and maintain information in multiple electronic health record (EHR) and Medicaid documentation systems. The position requires prolonged periods of sitting, keyboarding, and viewing computer monitors.

The position may require standing, walking, bending, reaching, kneeling, stooping, and lifting or carrying materials and equipment weighing up to thirty (30) pounds. Reasonable accommodations may be made to enable qualified individuals with disabilities to perform the essential functions of the position.

HIPAA and Data Privacy Obligations

Due to the nature of this position and its involvement with the Medicare members, you will have access to Protected Health Information (PHI) governed by the Health Insurance Portability and Accountability Act (HIPAA) and other applicable federal and state privacy laws.

This role has direct access to Protected Health Information (PHI). The following rules are non-negotiable:

• Absolute confidentiality: Employees must not disclose PHI to unauthorized individuals under any circumstances.


• Secure environment: A private, locked workspace must be maintained to prevent exposure of PHI to family members, visitors, or others.


• Company-approved technology only: All work must be performed on secure, company-issued devices using encrypted connections (VPN required).

You will be required to complete HIPAA training upon hire and annually thereafter. Any breach of confidentiality or unauthorized disclosure of patient information may result in disciplinary action up to and including termination and may carry legal consequences under state or federal law.

Other Responsibilities

This job description is not designed to cover or contain a comprehensive listing of activities, duties, or responsibilities that are required of the employee. Duties, responsibilities, and activities may change at any time with or without notice.

• Adheres to the policies and procedures of Community Health Solutions


• Maintains strict confidentiality of client, company, and personnel information


• Demonstrates a strong commitment to the mission and values of the organization


• Adheres to company attendance standards


• Performs other duties as assigned


• Completes all annual training assigned by the deadline for completion


• Will demonstrate successful completion and compliance with all policies and procedures, to be assessed during quarterly performance reviews


• Criminal background and OIG must remain in good standing.


• Will abide by the Ethical Code of Conduct set forth by the company, to be reviewed and signed yearly.

Remote / Hybrid / Flexible Work Requirements

Employees working remotely and accessing Company systems or Protected Health Information (PHI) must meet the following minimum requirements:

• Reliable, high-speed internet service capable of supporting Company applications and video meetings.


• Hotspots, public Wi-Fi, or unsecured wireless networks are not permitted while performing work involving Company systems or PHI.


• A private, secure workspace where confidential conversations and information cannot be viewed or overheard by unauthorized individuals.


• Ability to maintain compliance with all HIPAA, Company confidentiality, and information security policies.


• Company-issued computer and equipment must be used for all Company business unless otherwise authorized in writing.


• The remote workspace must be password protected and physically secure when unattended.


• Employees must lock their computer whenever stepping away from their workstation.


• Printed documents containing PHI should be avoided whenever possible. If printing is necessary, documents must be secured and properly destroyed using an approved shredder or secure disposal method.


• Family members, roommates, visitors, or other unauthorized individuals may not access Company equipment, systems, or confidential information.


• Employees must immediately report any lost, stolen, or compromised equipment, passwords, or suspected security incidents.


• Employees must comply with all Company cybersecurity requirements, including multi-factor authentication (MFA), password standards, software updates, and antivirus protection.


• Employees are responsible for maintaining a workspace that is safe, free from distractions, and suitable for productive work during scheduled working hours.


• Employees must be available during their scheduled work hours and maintain regular communication with supervisors and team members.

The Company reserves the right to inspect or request photographs of the remote workspace for purposes of verifying compliance with security, confidentiality, safety, and equipment requirements, when permitted by law and with reasonable notice.

Drug Free Workplace

Premier Family of Companies and its affiliates is committed to providing a safe, healthy, and productive work environment for all employees. To achieve this, CHS maintains a smoke-free and drug-free workplace. Candidates who receive a conditional offer must complete a pre-employment drug screen. Random and post-incident testing may also be required.

Confidentiality

You agree to maintain the confidentiality of all proprietary and non-public information obtained during your employment. This includes, but is not limited to, company records, financial data, client and vendor information, business strategies, and any other information not generally known outside the Company. You may not use or disclose such information during or after your employment, except as required in the performance of your duties. All company property and materials must be returned upon separation of employment.

Requirements

Qualifications:

• Licensure as a Registered Nurse in the State of Florida.


• A compact license is required, or provide documentation that you are currently in the process.


• A Minimum of three (3) years of recent adult clinical experience is required.

Additional Information

• SBU Name CHS - Chronic Care Mgmt


• Type of Position New to growth


• Employment Type Hybrid / Remote / Clearwater Fl.


• Employment Status Full Time - Exempt (Salary)